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Herbs

Clinical Herbalism

Clinical Herbalism involves meeting with an herbalist to discuss the use of medicinal herbs in assisting the body to come into balance, which can help with certain health concerns. Rooted and Lifted Herbals, LLC practices Western Herbalism, which has similar methods and philosophies to Traditional Chinese Medicine (TCM) and Ayurvedic Medicine. The use of diagnostic tests, such as facial, tongue, and pulse assessments, is incorporated in the herbal consultation, as well as a review of dietary and lifestyle routines. The primary goal is to identify medicinal herbs that may assist with the client's current health goals. Herbs can be used in the form of teas, tinctures (alcohol extracts), glycerites (vegetable glycerin extracts), vinegar extracts, syrups, as well as topical applications such as creams, salves, and oils infused with herbs.

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For a limited time, I will be offering free herbal consultations on a first come, first serve basis. Once the Client Intake Form (below) is completed and received, I will be in contact with you to schedule an appointment. At this time, I am traveling to clients' homes, within a 30 minute drive from Rockland, as I am currently working on an office space in my own home.

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Please fill out the Client Intake Form completely and with as much information as you can provide. Thank you!

Client Intake Form

*All fields must be filled out before you submit this form


*There is no way to save your work once you begin, and if you exit this page before you hit the submit button your work will be lost. You may email me for a Google Doc version of this form if you prefer

I. Personal Information

Today's Date
Biological Sex
Male
Female
Choose 3 words that describe your current feelings in life:

II. Diet & Nutrition

How many servings of the following do you have in a week?

Red Meat:
0
1-3
3-5
5+
Poultry:
0
1-3
3-5
5+
Fish/Seafood:
0
1-3
3-5
5+
Beans/Legumes:
0
1-3
3-5
5+
Eggs:
0
1-3
3-5
5+
Wheat Products (bread, pasta, etc.):
0
1-3
3-5
5+
Soy Products (tofu, soy milk, edamame, imitation meats, etc.):
0
1-3
3-5
5+
Dairy (cheese, milk, butter, yogurt):
0
1-3
3-5
5+
Fruits:
0
1-3
3-5
5+
Vegetables:
0
1-3
3-5
5+
Nuts/Seed:
0
1-3
3-5
5+
Fried Foods:
0
1-3
3-5
5+
Sweets/Baked Goods:
0
1-3
3-5
5+
Sugary Drinks (soda, juice, etc.)
0
1-3
3-5
5+
Coffee/Caffeinated Tea:
0
1-3
3-5
5+
Herbal Tea:
0
1-3
3-5
5+
Fast Food/Dining Out:
0
1-3
3-5
5+

III. Medical Information

Have you ever been diagnosed with any of the following? Provide descriptions and dates of each diagnosis below.
Select any symptoms that you have experienced, currently or in the past. Provide dates and time span of each symptom below.

Waiver of Liability

Clients are reminded that it is their personal right and responsibility to make educated choices in their own health and in their family's health. Rooted and Lifted Herbals, LLC does not make these choices for the client, but provides educational resources in the historic and traditional uses of herbs. The client understands that they have the final decision when considering any course of action.


The client understands that the herbalist of Rooted and Lifted Herbals, LLC is not a doctor, but is a holistic health educator. The herbal consultations that the client engages in do not constitute medical advice. No state or federal agencies regulate herbalism; and therefore, herbalists can not diagnose, treat, or prescribe medications.


I, the undersigned, understand the above paragraphs, and release Rooted and Lifted Herbals, LLC and all associates of this business from any liability. I also confirm that I am consulting with the herbalist on my own free will. I understand that there will be no diagnoses made or prescriptions given, but that an assessment of my general health will be made with lifestyle, dietary, and herbal recommendations.

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