Homeopathy Help Network

If you need financial assistance, we are happy to help. Please fill out the form below to request an acute consultation. Thank you!

Consult Type
Type of Consult Requested*
Your Availability*
The clinic is open from 9am-6pm Eastern, Monday-Friday. We can take cases anytime during these hours. However, we have students participating in the acute clinic training from 3-5 pm ET Monday-Friday. Can you be available for a 30-minute consult during that time?
- Yes, 3-5pm EASTERN today or tomorrow works!
- No, 3-5pm EASTERN doesn't work well.
Contact Information
Your Name*
First Last
Your Email*
Your Phone*
Are you the one needing care? - Adults (or parent if a minor) must sign Consent Form below*
- Yes
- No
Your relationship to the client:*
Does the client know you're contacting Homeopathy Help Now on their behalf?*
- Yes
- No
Client Name*
First Last
Client Phone*
Client Email*
Client Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Client Date of Birth*
Client Gender*
- Male
- Female
- Gender Non-Confirming/Diverse
Preferred Method of Client Communication
- Online Video Conference
- Phone Call
Are you or your family currently working with a practitioner on our team?
- Yes
- No
If yes, please give the practitioner's name:
How did you hear about us?
Health Information
Date Symptoms Began*
MM slash DD slash YYYY
Please briefly list what you are experiencing.*
Pre-existing Conditions*
Have you (the client) been vaccinated for CV19?*
- Yes
- No
Which COVID-19 vaccine did you get?*
Have you been tested for COVID-19?*
- Yes, I'm positive now
- I previously tested positive
- I have not tested
- I've tested COVID negative
Current or Recent Medications & Labwork*
Is the client familiar with homeopathy?
- Yes
- No
Does the client already work with a homeopath?*
- Yes
- No
Does the client have access to homeopathic remedies at home or locally?*
- Yes
- No
Are you requesting a specific practitioner on our team?
Have you been referred to our organization from a specific place or person?
Sliding Scale Fees
Do you need a free acute consultation?*
- Yes, I need a free consultation
- No, I can pay the amount below
Pay what you can afford
To fund the non-profit work of HOHM Partners Foundation to provide free and low-cost homeopathy care, our suggested donation is $40 for a single consultation. If you need financial assistance, please pay what you can afford or check the box below to request a free consultation.

Credit Card*

Cardholder Name

Card Details

Total
$0.00
Agreement for Consultation
Our work together

Homeopathy views health from a holistic perspective. Homeopaths do not make any sort of diagnosis in medical terms and it is your responsibility to maintain a relationship with a licensed physician or primary care provider for appropriate evaluations and check-ups.

***Under no circumstances should any suggestions be taken as a medical diagnosis or direction against a licensed medical or mental health care professional.***

By agreeing to our terms of service you agree to the following:
- I understand that the goal of homeopathy is to increase my (my child’s) general vitality and constitutional strength and that no specific disease will be diagnosed or treated.
- I authorize discussion of my case notes with other professional Homeopaths if my (my child’s) best interests are served by such a consultation. My right to privacy will be protected by withholding my name and any other identifying information.
- I am over 18 years of age and have voluntarily chosen homeopathic support for myself/my child.
- I am aware that that the outcome and duration of homeopathic support vary by individual and cannot be guaranteed. And that the assigned Homeopath further offers no warranty or guarantee as to the outcome of the homeopathic support.
- I agree that I have a choice with regard to where I obtain homeopathic remedies recommended.
- I understand that these services are being provided on a donation basis, and I am under no obligation to pay a fee for the services provided for the acute condition I am receiving a consultation for.
- I am aware that my assigned Homeopath is working on a voluntary basis and as such, I waive all legal rights that may arise from the homeopathic support and hold the assigned Homeopath harmless from all claims, present and future, known or unknown, in any manner arising out of the homeopathic support.
- This Agreement shall be governed by the laws of the State of Arizona and the venue of any action brought concerning the interpretation or enforcement of this Agreement shall be proper in the county the Homeopath resides.
- The Parties agree that the terms and provisions of this Agreement embody their mutual intent and that such terms and conditions are not to be construed more liberally in favor of, or more strictly against, either Party.
- If any provision herein is invalid, it shall be considered deleted from this Agreement and shall not invalidate the remaining provisions of this Agreement.
- I understand that the Homeopath I will be scheduled with is not a medical doctor and does not diagnose. All recommendations are for wellness and overall health building purposes.
Client Consent & Signature*
I verify that I have read and understand the terms of service outlined on the Terms of Service page.
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If you don't get an email confirmation the form was not submitted. Please resubmit and check that all fields are completed.

Your support helps HOHM Foundation champion the Education – Advocacy – Access that are critical to creating a new context for health. Thank you!

HOHM FOUNDATION

HOHM Foundation is a 501(c)(3) organization committed to closing the gap between traditional and conventional medicine by elevating the principles and practice of classical homeopathy. We champion a unified homeopathy community through our deliberate and impassioned approach to the future of healing, centered on education, advocacy, and access for all.

Academy of Homeopathy Education

Academy of Homeopathy Education (AHE) offers 100% virtual classical homeopathy training with full-time and part-time options. Students receive live clinical training in a robust student clinic.

A coalition of professional practitioners and students working to further the mission of HOHM Foundation to provide accessible homeopathy care.

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Consultation Request-Financial Assistance

If you need financial assistance, we are happy to help. Please fill out the form below to request an acute consultation. Thank you!

Consult Type

Contact Information

Health Information

Sliding Scale Fees

Agreement for Consultation

Our work together

HOHM FOUNDATION

Academy of Homeopathy Education

homeopathy help network