Terms & Policies
OFFICE POLICES AND INFORMATION:
Follow up: It is important to follow up within 30-45 days after first visit. Be prepared to make the commitment to your health and follow through on an action plan. Depending on condition of health, this can take from 3 months to 6 months possibly even 12 months, but varies from client to client. I understand and agree to allow Purely Simple Organic Living, LLC. to use information in this form for the purpose of developing a C.A.R.E. plan and coordination of care.
Purely Simple Organic Living LLC does not administer emergency medical care. In the case of an emergency, please see your family physician or the emergency room of the nearest hospital.
Payment is expected in full at time of service. Cash and credit cards are accepted. There is a 3% processing fee for credit cards. A $40 fee is charged for returned checks. We do not accept Medicare, Medicaid, medical assistance or handle insurance claims.
On occasion, Purely Simple Organic Living LLC will negotiate to accept partial payment, or at our discretion, waive payment, based on individual client circumstances. We do not refund services that have already been provided. We do not provide refunds on programs. I understand and agree to allow Purely Simple Organic Living, LLC. to use information in this form for the purpose of collection of outstanding payments and healthcare operations.
Supplement purchases are separate from fees for services. Payment for supplements is expected at time of purchase. I DO NOT ACCEPT RETURNS ON PRODUCT PURCHASES.
Right to Refuse Service:
Purely Simple Organic Living LLC has the right to refuse service to you as a client based on compliance or repeated lateness or cancellation.
If 2 No Shows or cancellations/reschedules with less than 24 hours’ notice have occurred, Purely Simple Organic Living LLC will require pre-payment for future appointments. These pre-paid appointments will have to be scheduled by phone during business hours or in PERSON. Not showing for a pre-paid appointment will result in forfeiture of pre-paid amount.
I agree to pay for services rendered at time of service. I consent to treatment as agreed upon between Purely Simple Organic Living LLC and myself. I have read and understand the policies of the Purely Simple Organic Living LLC. I agree to comply with the
CLIENT AGREEMENT FORM:
I acknowledge that the Biochemical Wellness Profile and any other modalities offered and accepted, Suggested Nutritional Program and any supplemental materials such as vitamins, mineral, enzymes, homeopathy and herbs are not for the diagnosis, treatment, cure, alleviation, prevention or care of any disease of any kind and in any way I agree that I am totally responsible for obtaining qualified medical assistance for any such services or for the care of any disease or pathological condition. I further declare that the sole reason for Consultations are limited to education in matters pertaining to the improvement in the overall health and physical fitness for maintenance of the best possible state of physical, mental and emotional health. These subjects may or may not include the examination of or urine and saliva. Such procedures are not for the diagnosis or treatment of any health condition or disease. Any products and lifestyle suggestions, including fasting are at my own risk and choice.
I fully understand that Christina Sessums, MSW, CNHP, INTERN CAHP, D.PSc. and Purely Simple Organic Living LLC deals strictly in helping people improve their general health through better nutritional approaches improved lifestyle, improved health habits and positive mental attitudes. I fully understand that employees of Purely Simple Organic Living LLC and Christina Sessums, MSW, CNHP, INTERN CAHP, D.PSc. are not licensed physicians and cannot diagnose diseases, prescribe drugs or recommend treatments for specific disease conditions.
I certify that Christina Sessums, MSW, CNHP, INTERN CAHP, D.PSc. and Purely Simple Organic Living LLC has not suggested that I cease any medical care I may be undertaking. I understand that decisions I make regarding my health care and the health care of those under my guardianship are my responsibility and certify that I will not hold Christina Sessums, MSW, CNHP, INTERN CAHP, D.PSc. and Purely Simple Organic Living LLC responsible for the consequences of my decisions. These services are not a substitute for prompt medical attention needed. Natural attempts will be made to relieve discomforts, but if a medical professional is needed, seek medical attention or verify recommendations with a primary physician.
I certify that I am here on this day and on any subsequent visits or contact, whether by mail, telephone, or in person, solely on my own behalf and not as an agent or representative of any federal, state, county, or local government or private agency on a mission of investigation. I am not a representative of a branch of a municipal, state, U.S. Government, the American Medical Association or the Federal Drug Administration. I, under penalty of perjury, I am not an agent of any branch of the federal, state or local government for agency thereof. I, under penalty of perjury, I am not an agent of any branch of the federal, state or local government for agency thereof, with intent to entrap or entice Christina Sessums, MSW, CNHP, INTERN CAHP, D.PSc. and Purely Simple Organic Living LLC or any of its owners, employees and/or associates into breaking any federal, state, or local laws whatsoever acting either on my own behalf, or on the behalf of the agency of government.
I have read and fully understand the above listed information and I do hereby request that I be allowed to participate in a health consultation and services provided by Purely Simple Organic Living LLC. I am aware Purely Simple Organic Living LLC is a Private Membership Association.
This Pastoral Medical Association (PMA) practitioner does not practice medicine. More specifically, this practitioner does not: examine, diagnose, treat, offer to treat, cure, or attempt to cure: any physical or mental disease or disorder, or any physical deformity or injury. Nor does this practitioner prescribe or recommend any drugs or medicine. I am not a medical doctor, a mental health doctor, dietician, or nutritionist. I do not play a doctor on TV. I do not hold a degree in medicine, dietetics, or nutrition. Information provided on this site and at our clinics is based on our opinion and is intended for educational purposes only. What you do with the information and how you choose to or not to apply it is solely your responsibility. We may use medical terminology as a point of reference and or clarification only. Please consult with your medical team, and then make your own well informed decisions based upon what is best for your genetics, your culture, your conditions, and age.