Intake Form

I understand that all information disclosed to Emily Frye is confidential and may not be revealed to anyone without written permission, except where required by law. Disclosure may be required in the following circumstances: a reasonable suspicion of child or elder abuse; a reasonable suspicion that a client presents a danger to him or herself or others.

I have voluntarily chosen homeopathic treatment for myself/for my child. I understand that Emily Frye is a homeopath, not a licensed physician, and that the State of Texas does not license homeopathy. Since she provides consultations for homeopathic treatments only and does not perform any form of medical examination, diagnosis, or operative procedures, as such, I acknowledge that it is my right and responsibility, at any time throughout my treatment with Emily Frye, to seek medical counsel and diagnosis, if so desired, from a medical doctor, for any present and/or future condition(s).

I also reserve the right to terminate homeopathic treatment at any time if so inclined. I acknowledge that the state of my health is my own responsibility and that I am exercising my right to choose an alternative method of treatment, in homeopathy, that addresses my health in its entirety. I understand that Emily Frye will work to increase my/my child’s general vitality and constitutional strength through homeopathy. I consent and further acknowledge my consent to receive her homeopathic services.