JILL ELLIOT, DVM, MSW, LLC
“NY Holistic Veterinarian”
at Heart of Chelsea Animal Hospital
257 West 18th Street (corner 8th Avenue)
New York, New York 10011
Telephone: 212-741-4000; Fax: 646-863-9119
“The highest ideal of therapy is to restore health rapidly, gently, permanently; to
remove and destroy the whole disease in the shortest, surest, least harmful way,
according to clearly comprehensive principles.”
Samuel Hahnemann, M.D.
Aph. 2 Organon of Medicine
CLIENT ACCEPTANCE FORM (FORM #050515)
WE WANT TO ACKNOWLEDGE YOU for having an open mind and for looking into holistic
treatment for your beloved furry family member. To get to this point you have embarked
on a journey of exploration and re-education. Thank you for taking that giant step into a
new and not to easy to understand but highly effective, time honored treatment modality.
Now let’s get to work restoring your pet to health.
OUR PRACTICE OF MEDICINE provides a very different experience from conventional
veterinary medicine. Classical Homeopathy can be used to treat a broader range of
problems than those treated conventionally. However, this modality is not magic. Like
conventional medicine, it cannot resolve every problem successfully.
CLASSICAL HOMEOPATHY, nutrition, and natural supplements will be used as the
primary basis for the first line of treatment for your pet’s problems regardless of the
diagnosis, prognosis or conventional protocol for treatment. Some conventional
treatments may be employed.
HOMEOPATHIC MEDICINES – What are they made of?
The substances used in homeopathic remedies are derived from plant, mineral and animal
sources. When properly prepared, these substances acquire the ability to heal gently
without any side effects. All homeopathic medicines are approved by the FDA and are
safe for all humans, babies and animals.
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Office Locations and Hours:
Dr. Elliot’s primary office is at the Heart of Chelsea Animal Hospital, 257 West 18th
Street (corner 8th Avenue), NYC. She sees patients at this location Monday, Tuesday, and
Wednesday 9:00 am – 7:00 pm by appointment only. On Thursdays she sees patients at
Lenox Hill Vet Hospital, 204 East 76th Street, NYC, from 9 am – 3 pm by appt. only.
Dr. Elliot works one Saturday per month at Lenox Hill Vet Hospital from 9am - 2 pm.
To make an appointment at either location, please call her at 212-741-4000.
Cost of Services:
Our consultation fees for initial Intake Visit: $399.00.
The first in-office visit usually runs one hour. This fee also includes time spent doing a
comprehensive homeopathic computer analysis of your animal’s case before, during or
after your intake appointment.
The first remedy if in pellets/envelope (not liquid form) is free whether given in the
office or mailed to you afterwards. After the first remedy, there is a dispending fee for
additional remedies.
First remedy if pellets: no charge
First remedy if liquid in 1 oz. Bottle with dropper:
$46.00
The time between follow up appointments is three to eight weeks, depending on the
severity of the case. In acute cases, follow-up appointments will be more frequent.
Follow up in office appointment fee is $ 100.00.
FEES FOR DISPENSING REMEDIES (after the first visit)
Envelopes/pellets……………………………………………………………$26.00/ per envelope
Liquid remedies
One ounce bottle with dropper or spray cap…………$46.00/ per bottle
PAYMENTS ACCEPTED BY: MasterCard, Visa, Amex, Discover, Checks and Cash.
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Fees for Homeopathic Consultations/Intakes on the Telephone/without an office
visit:
Telephone only intake consultations for homeopathic treatment are available for pets
with special circumstances (live out of town/can’t be transported/etc.).
Fees: One half hour (30 minute) intake call: $175; 45 minute intake call: $285.00.
Includes fees for computer/case analysis, which may happen after the call.
(An office intake is always preferable for the first consultation. After the initial office
visit, telephone follow-up appointments can be arranged to discuss animal’s response to
homeopathic treatment.) Fees will be pro-rated based on time spent on telephone.
FEES FOR TELEPHONE CONSULTATIONS/FOLLOW-UPS:
Fees for follow-up calls: During regular working hours:
(Monday through Wednesday: 9:00 AM – 7:00 PM)
Brief call – No charge.
15 Minute call…………………….$35.00
Fees for Emergency Calls after regular office hour calls:
(Monday through Thursday: before 9:00AM or after 8:00 PM; Saturday: before 9:00AM
or after 6:00 PM; Friday & Sunday/holiday; anytime):
5 Minute call……………………$40.00/ 10 Minute call………………….$70.00
FEES FOR IN-OFFICE EXAM/RE-CHECK AFTER INITIAL INTAKE: $100.00
FEES FOR HEALTHY PET IN-OFFICE EXAM (WELLNESS EXAMS): $100.00
NOTE: If your pet is showing any signs of illness that concerns you, PLEASE CALL
DURING NORMAL BUSINESS HOURS TO SPEAK WITH DR. ELLIOT. THIS WILL
ALLOW US TO PROVIDE THE BEST SERVICE TO YOU AND FOR YOUR PET. YOU WILL
HAVE THE MOST OPTIONS FOR CARE. No calls will be returned after 8:00 PM unless it
is an emergency.
We request at least 24 hours cancellation notice. To reschedule or cancel please call the
main phone number only 212-741-4000.
SATURDAY APPOINTMENT CANCELLATION FEE: We require 24 hr. cancellation
notice for Saturday appointments. A $25.00 fee will be charged if no cancellation
notice or last minute cancellation notice. Sorry but Saturday appointments are highly
sought after. Call 212-741-4000 or 917-612-1391 to cancel a Sat. appointment.
There is a $25.00 returned check fee if your check bounces.
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WHAT YOU CAN DO TO ASSIST IN THE PROCESS OF YOUR PET’S CARE:
1.
Monitor your pet well and keep good records. This is essential.
You are an active member of your pet’s treatment team. The decisions made at
each point in the treatment depend on your accurate observations, and, our degree
of success depends on this.
2.
PLEASE DO NOT ADMINISTER OR DISCONTINUE ANY MEDICATIONS OR
SUPPLEMENTS WITHOUT CONSULTING WITH US FIRST. THIS INCLUDES
ALL SERVICES OFFERED BY YOUR LOCAL/CONVENTIONAL VETERINARIAN
FOR ROUTINE MATTERS AND EMERGENCIES.
3.
Be on time for all appointments to help us keep on schedule.
4.
Please bring the following to the first appointment (if possible):
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A photo of your pet.
A brief record from a recent veterinary exam (if possible) indicating a
diagnosis.
Any recent test results (blood work, urine analysis, and ultrasound report if
done, etc.).
X-rays, pertinent to the case (if available).
A list of all medications and supplements currently being taken.
A list of all homeopathic medications given in the past (with dates and doses)
if applicable.
Last date of vaccinations and list of which were given.
We prefer that you bring this information with you to your first appointment; if you
have a telephone consultation mail OR fax (646-863-9119) them to us at least one day
prior to the office visit. Please do not mail X-rays.
Please fill out one copy of the Declaration of Acceptance below. Bring it with you to
our first visit COMPLETELY FILLED OUT to save time.
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JILL ELLIOT, DVM, MSW, LLC
“NY Holistic Veterinarian”
c/o Heart of Chelsea Animal Hospital
257 West 18th Street (corner 8th Avenue)
New York, New York 10011
Telephone: 212-741-4000; Fax: 646-863-9119
DECLARATION OF ACCEPTANCE
I have read and understand the four-page Client Acceptance Form (Form #050515). I
agree that I want Classical Homeopathy to be used to treat my pet(s). I further state
that I am not expecting any other treatment than what is described here.
NAME (Please print):_________________________PET’S NAME(S):_____________
CLIENT SIGNATURE:_____________________________DATE:_____/_____/2015
I authorize the use of my credit card (Visa, MasterCard, Discover or American Express)
by Dr. Elliot over the phone:
Card Number: _____________________________________________
Expiration Date: ___________________________________________
Name as it appears on card: __________________________________
_______I authorize Dr. Elliot charging my credit card directly after telephone follow-up
appointments or for other services.
Signature: ______________________________________
Please be sure to sign this form in both places. Thank you. Please bring this with you to
the first appointment or one day prior to your appointment, fax this sheet back to Dr.
Elliot at 646-863-9119. Thank you.
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