Consultation Forms
Complete the forms below before your consultation. Fill out online, sign digitally, then click Send to Practitioner.
Private Membership Agreement
The Butterfly’s House operates as a Private Membership Association (PMA) — a private ecclesiastic research society whose services are available exclusively to members. Joining protects both you and the practitioner under common law and private contract, outside the jurisdiction of public regulatory bodies.
Practitioner-Client Service Agreement
Please read and sign before your first consultation. Covers office policies, virtual appointment procedures, fees, insurance, client rights, HIPAA acknowledgement, and consent to evaluate and treat.
New Adult Consultation
Complete before your first consultation. Covers health history, medications, vaccination history, body systems, and timeline of major life events. Fill online or print and mail.
New Pediatric Consultation18 Years & Under
Complete before your child’s first consultation. Covers developmental history, behavior, pregnancy and birth details, body systems, and a timeline of major events. Requires parent or guardian signature.
Acute Care Consultation
For sudden-onset conditions not under constitutional care — fever, cough, injury, acute headache, and similar complaints.