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Client Forms


New patient forms

  • New patient health assessment form: Complete Health Assessment Form - Highly recommended for all new patients to complete but not a requirement.  By completing this comprehensive assessment tool I will have a clear understanding of your [doshic] imbalances and the health of your organs, tissues and systems.

  • Short new patient intake form: Short Health Assessment Form - For acute and simple health conditions or for those who only need preventive care.

Notes: When completing the online forms, please do so within an hour or you may have to start over.  You will need to sign and submit the form at the end.  The forms are not printable but if you want to complete a form by hand request a printable version.  Alternatively, forms can be completed in my office.  If you wish to complete the form on the day of your appointment, please arrange to come 30 minutes early.

Returning patient forms

  • Returning patient assessment form: Tissues & System Assessment Form - Helpful (but not required) for returning patients after 3 months and highly recommended for returning patients after 6 months or more.

  • Daily Journal for existing patients: Daily diet & Lifestyle Journal - For active patients seeking feedback.
Your information remains completely confidential and private.*

* Privacy

We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information.   Your personal information is contained behind secured networks and is only accessible by a limited number of persons who have special access rights, and are required to keep the information confidential. The complete privacy policy.

* Security

All transactions are processed through a gateway provider and are not stored or processed on our servers. Forms (from the links above) are available securely online and managed by SeamlessDocs.com, New York, NY.  (SeamlessDocs utilizes bank grade security and proprietary encryption techniques to ensure the highest level of security for your documents and data.)

To discuss your case after completing a form please contact Khabir at:
1-805-308-3480


Details

Days & Times

The clinic is available for last minute appointments, however, an appointment is still required.  Appointments are generally scheduled Monday through Friday between 9:00am to 6:00pm with availability on weekends and evenings upon request.

Family Consultations

Many families find they share the same health challenges and/or wish to implement lifestyle changes as a family instead of restricting healthy changes to a single member of the family. I am happy to consult with families and couples together. Bring your partner or family member to support you!

Payment Policy

Payment for services is required at the time of appointment for office clients or in advance for remote clients (i.e. Skype, email, Google Hangout, phone).  Detailed receipts will be provided by email for all services and products purchased.

Visa, MasterCard and Amex are accepted. PayPal is also accepted. Checks should be payable to Natural Healing Consultants.

Cancellation Policy

Appointments missed or cancelled in less than 24 hours will incur a $50 charge. Exceptions to this policy may be made for emergency situations on a case-by-case basis.

Products

Teas, herbal formulas, supplements, spices, oils and other products are not included in consulting fees or programs unless specifically stated.  We use the highest quality, ethically wildcrafted, pure, and organic herbs in our herbal preparations. * Herbal product costs: Generally, $15 for a 2 oz jar; $25 for a 4 oz jar; and $35 for a 6 oz glass jar of powdered herbs; $15 or $20 for a 2.5 oz or 3.0 oz bag of loose herbal tea blends; and $15 for 4 oz of herbal oils. Prices are sometimes adjusted based on the cost of the ingredients not the weight.  (Herbal products may be shipped in plastic bags instead of glass jars.)

Insurance

We do not bill insurance directly, but we will prepare a detailed bill which you can submit to your insurance company for reimbursement, if your insurance covers naturopathic or nutritional therapy visits.  We do not bill Medicare.


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Khabir Southwick is available for [face-to-face] consultations in Ojai California or remotely by phone or Skype worldwide. Click here to request for more information.

Call 805-308-3480 for more information or to leave a message. For general inquires: email khabir@ksouthwick.com

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Contact Info

Office Location:
723 Fernando St. Ojai - Business licence #8111 (by appointment)

Mailing Address:
226 W. Ojai Ave. Ste 101-177 Ojai, CA 93023

Contact Info:
Office: (805) 308-3480 - Call anytime.
Skype Name: KhabirOfOjai
Email: khabir@NaturalHealingOjai.com

© 2009-2017 Khabir Southwick