Informed Consent and Practitioner Disclosure
Effective Date: April 28, 2026
1. Nature of Services
Services may include homeopathic consultation, HTMA interpretation, nutrition and lifestyle education, emotional wellness support, and related complementary wellness services. These services are complementary and educational in nature and are not conventional medical diagnosis or treatment.
2. California Practitioner Disclosure and Client Acknowledgment
Client acknowledges receiving and understanding the following disclosures:
Services are provided by Je’ Willkomm, OTR/L, a California-licensed Occupational Therapist and Integrative health practitioner.
The practitioner is not acting as a medical physician (M.D. or D.O.) in providing these services.
No services are represented as diagnosing, curing, preventing, or treating disease.
Client acknowledges that the practitioner has advised the client to maintain an appropriate relationship with a licensed physician or other appropriate licensed medical provider and to seek medical evaluation or treatment when appropriate.
3. No Emergency or Crisis Care
These services are not licensed primary care, specialty medical care, or emergency services. If you are experiencing an emergency, call 911 or seek immediate care.
4. No Guarantees
No representation, warranty, or guarantee is made regarding any particular result or outcome.
5. Client Responsibility
You remain responsible for your own healthcare decisions and participation is voluntary and based on informed choice.
6. Risks and Limitations
Complementary wellness approaches may involve uncertainties and may not be appropriate for every person or circumstance.
7. Products and Supplement Guidance
Discussion of supplements or wellness products is educational in nature. Clients are responsible for reviewing labels and using products only as directed.
8. Electronic Communications and Privacy
Communication may occur through email, phone, text, virtual services, or Acuity Scheduling. Good-faith efforts are made to use privacy-conscious systems; however, electronic communications carry inherent privacy risks and complete security cannot be guaranteed.
9. Client Acknowledgment and Consent
I acknowledge that:
I have read and understand this informed consent and practitioner disclosure.
I understand these services are complementary and not medical or emergency care.
I acknowledge I have been advised to maintain an appropriate relationship with a licensed physician or other appropriate licensed medical provider.
I understand no outcome is guaranteed.
I voluntarily consent to receive services.