The Village Herbalist
28 Main Street
Millerton, NY 12546
Phone: 518-592-1600
Informed Consent and Disclosure Form
About TVH
The Village Herbalist is an herbal apothecary and clinic located in Millerton, New York. It was
founded in 2011 by local resident and herbalist, Terri Lundquist. Its purpose is to share the ancient
wisdom of how to heal with Nature’s pharmacy. TVH offers herbal consultations to clients by
appointment and herbal education classes at the wellness studio, and apothecary remedies and
natural products and gifts at the retail shop.
My Philosophy
I believe that knowledge of how to heal ourselves--body, mind, and spirit--lies within each of us. I
also believe that healing should be gentle, accessible, and affordable. At TVH, I work with whole
plants to heal the whole person. Herbalists don’t isolate body parts or diseases. We see the
interconnections in the human body and work to gently nudge all pieces back into balance. My goal
at TVH is to help bring you into balance in a way that is gentle and natural by uniting modern
science with long-established traditions in healing practices.
What to Expect
Today’s herbalists have a variety of time-tested diagnostic tools borrowed from thousands of years
of Chinese and Ayurvedic medicine. Herbalist’s tools are non-invasive and do not require expensive
tests. I am happy to look at previous medical testing, but will rely mainly on direct observation and
listening in order to come up with a healing protocol for your specific needs.
The initial in-person consultation will last approximately one-and-a-half hours. That time is reserved
for us to get to know each other. We will discuss your reason(s) for visiting, your health and family
history (including diet and lifestyle), and your current health goals. Approximately one week from
the initial visit we will schedule a shorter follow-up visit to go over recommendations. At this time
you will be given a protocol designed specifically for you based on my training and experience and
supported by traditional wisdom and modern research. In acute situations, I will be able to send you
home with remedies from the apothecary that will support the appropriate body system.
Every formula is blended purposely for your needs and with consideration for your lifestyle. We can
change formulas as your body begins its healing process or as your desire to heal in different ways
grows and changes.
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An initial phone consult is also available. It is designed for the client who is interested in working on
a single issue and therefore doesn’t need the full medical history and health goal assessment. The
phone consultation will last approximately one hour and will be a more directed, shortened version
of the in-person consultation.
I am happy to work in conjunction with your physician’s instructions and guidelines. I recognize that
modern medicine serves an important role in our society and our health. As an herbalist, I also
recognize that it can be stronger than some traditional practices and therefore, harsher on our
bodies. In that case, I work with herbs to bring you back into balance. The ancient wisdom supports
the modern medical treatment quite well.
Confidentiality and Code of Ethics
All information discussed in the context of the herbal consultation is completely confidential and
will be treated with the utmost respect and care. In the spirit of the American Herbalist Guild’s
Code of Ethics, I invite you to report any dissatisfaction or problem with my professionalism in the
form of a grievance to the Guild. Letters can be mailed to: American Herbalist Guild, 141 Nob Hill
Road, Cheshire, CT 06410.
Professional Training
My training began with Rosemary Gladstar, one of the finest herbalists in the country. After
beginning the Gladstar herbal study course, The Science and Art of Herbalism, I had the good
fortune to join Rosemary’s Intensive Apprenticeship program at Sage Mountain in Vermont. My
studies took a more clinical turn at the Vermont Center for Integrative Herbalism (VCIH). VCIH
offers herbal students a comprehensive Clinical Herbalist training program that prepares them for
work in the community clinic and with their own clients. Today, I continue professional
development through conferences, advanced education seminars, on-going research and
professional networking.
Scope of Practice
Herbalists are not medical doctors. We do not diagnose, prevent, cure, nor treat any diseases. At
TVH, I believe that ordinary people, by ordinary means, can have access to healthy living. You can
be empowered to heal specific conditions with plants that grow in your backyard or in your window
box. My primary role is as educator and partner. I can show you how to best enhance your body’s
innate healing ability; however, ultimate responsibility for health and well-being is your own. At
TVH, I fully encourage you to be an active participant in the process. Please ask any questions
during the consultation and if you leave the office and have more questions, call me. Please let me
know what is working for you and what isn’t working for you. If you disagree or are uncomfortable
with a recommended protocol, let me know. I will listen.
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Disclosure
Herbs are generally extremely safe and most common herbs have no drug interactions. At TVH, I
prefer to work with herbs that are generally recognized as safe. However, there are some cases
where special care and consideration must be taken. It is your responsibility to fully disclose any
medical conditions and any medications or supplements currently in use. I also recommend that you
inform your doctor of all herbal and nutritional supplements you are taking. In the event of an
adverse reaction to an herb, immediately discontinue use and call me.
Herbs should not be used in pregnancy or lactation without expert advice. If you become
pregnant, I recommend you immediately stop taking herbs and call to schedule an
appointment with me. There are many safe herbs for pregnancy and many herbs to support a
woman during this time; let a trained herbalist guide you in the right choices.
Terms of Payment
Payment is expected at the time of your visit. The initial fee for an in-person consultation is $75.00.
Research related to your protocol is an integral part of my practice and, as such, is included in the
initial fee. Subsequent visits are charged at $30.00 per half hour. Any additional research specially
requested by the client but not related to your initial visit will be charged at $45.00 per hour and a
maximum number of hours will be agreed upon before research begins. In the interest of making
traditional herbal knowledge available to all, TVH offers a sliding scale fee. Please speak to me if
you have questions about the sliding scale.
All apothecary shop items are sold separately, including tinctures or teas recommended as a result of
an herbal consultation. I believe you should be free to purchase remedies where you like and I am
happy to supply a list of resources about products I have found to be of high quality. Further, if you
have an interest in making your own remedies I will do everything I can to educate you in the proper
techniques.
I ___________________________________ acknowledge that I have read and understood this
document. I hereby voluntarily consent to an herbal consultation within these parameters. I
acknowledge that herbal education is not a substitute for regular medical care and that the herbalist
and any staff at TVH are not licensed physicians. All information is shared in the spirit of
empowering me to better understand and heal myself.
Dated: ____________________
Signed: _________________________________
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