Mark Pillans

    Patient forms

    Herbal patient consent form:

    PDF files

    Consent form – adult herbal treatmentDownload
    Consent form – child herbal treatmentDownload

    Herbal patient intake forms:

    PDF version

    Intake form – constitutionDownload

    Word document version

    Intake form – constitutionDownload

    Healing pre-treatment consent forms:

    PDF version

    Healing treatment consentDownload

    Word document version

    Healing treatment consentDownload

    If you intend to email me sensitive data, I recommend you consider setting up a Protonmail email account (free via https://protonmail.com), which will keep your information securely encrypted and only accessible between ourselves (My email – but not the contact form via this site – runs through Protonmail. You can still email me from any email system, but non-Protonmail accounts will not be encrypted).

    Contact me