Only a physician can diagnose and treat disease, and prescribe medication. As an herbalist and not a physician, I do not diagnose or treat disease, or prescribe medication. By signing below you acknowledge that I am not a health care provider, but rather I am helping to inform the decisions that you make regarding your wellbeing. The human body has the innate power to heal itself. Without this power to self-heal, even the most advanced medications and surgical procedures would ultimately fail. The role of the herbalist in the healing process is to consider the client as a whole person, and to consult the client concerning changes in lifestyle, diet, and supplementation in order to foster an increased state of balance and health, thus maximizing the body’s self-healing capabilities. Although rare and usually minor, certain side effects, including allergic reaction, can sometimes occur from natural remedies. I advise and encourage clients to seek professional medical diagnosis and advice regarding any illness or symptoms they are experiencing, and to inform their physician of any and all supplements they are taking. This in turn will aid in the process of a holistic herbal consultation. With this in mind, I ask all clients to bring with them to their consultation any test results, written diagnoses, or other medical information regarding their condition. As appropriate, as a client you also agree that if you are trying to conceive or believe you may be pregnant that you will inform me, and understand that certain herbs or supplements may be inappropriate to use during pregnancy. Signed, Amanda Crooke, Clinical herbalist Please type the following below: "I have read and understood this form."