CLIENT BILL OF RIGHTS
Conni J. Conner
3622 Thomas Ave N
Minneapolis, MN 55412
I am pleased to provide you with this Client Bill of Rights, in accordance with Minnesota laws governing complementary and alternative health care practices.
1. Degrees, training, and experience: Conni has practiced as a classical homeopath since 1999. She graduated from Northwestern Academy of Homeopathy, a three-year program in Minneapolis, MN in June 2000. Completed Level III Cranial
Sacral training under Carol Phillips, DC. Prior training includes over two years of RN training at St. Mary's Campus, Minneapolis, MN from 1990-1992.
In accordance with Minnesota state law, I am providing you with the following notice:
THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY
AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY.
Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuation of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor or acupuncture practitioner, or services from a physician, chiropractor, nurse, osteopath, physical therapist, dietitian, nutritionist, acupuncture practitioner, athletic trainer or any other type of health care provider, the client may seek such services at any time.
2. Right to file a complaint. If you have any concerns, you may file a complaint with the following office:
Office of Unlicensed Complementary & Alternative Health Care Practice
Minnesota Department of Health
85 East 7 Place
St. Paul, MN 55101-2192
3. Fees for unit of service.
Initial Homeopathic Consultation (approx 2 hours) $125 (includes remedy)
Follow-up Consultation (up to one hour) $45 (does not include remedy)
Telephone consult (over 15 minutes) $20 (does not include remedy)
Remedy charges: Pellet remedies start at $10; prices vary (includes shipping).
LM potencies start at $15.00, which includes shipping.
Fees are payable at the time of service. I do not accept Medicare, Medical Assistance, or General Assistance Medical Care. If you are unable to pay the full fee at the time of service, a payment plan can be arranged, which must be agreed to in writing.
4. Change in services or charges. You have a right to reasonable notice of changes in services or charges and I will provide prior notice of any changes.
5. Summary of Practices/Services. Please review the attached document that provides a detailed description of classical homeopathy. If you have any questions, please ask.
6. Information about assessment and recommended service. You have a right to complete and current information concerning my assessment and recommended service, including the expected duration of the service to be provided. If you have any questions, please ask.
7. Courteous treatment. You may expect courteous treatment and to be free from verbal, physical, or sexual abuse by the practitioner.
8. Confidentiality of client information. Your records and other information about you are confidential. This information will not be released, unless you authorize release in writing, or unless law requires release.
9. Access to client records. You are allowed access to records and other written information, in accordance with Minnesota Statutes, section 144.335.
10. Other available services. If you are interested in other available services in the community, you may wish to consult the Minnesota Homeopathic Association.
11. Change practitioner. You have the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs.
12. Coordinated transfer. If you change practitioners, you have the right to our assistance in coordinating this transfer to another practitioner.
13. Refusing services. You have the right to refuse services or treatment, unless otherwise provided by law.
14. No retaliation. You may assert your rights without retaliation.
I hereby acknowledge receipt of the Client Bill of Rights and the attached documents incorporated therein, and I have had a full opportunity to ask any questions I have about this document and my rights as a client. I understand my rights as a client.
Client Signature Date
Parent or Guardian Signature Date