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Khabir's Online Clinic Forms

For all new and prospective clients 

Form Used for
   
 Complete Health Assessment Form This comprehensive health assessment form is for new clients so Khabir can evaluate your health condition from a traditional Ayurvedic perspective and understand your health history.
   
Existing Client Form - For follow-up appointments Used for returning clients with new health conditions or returning after two years or more. 
   

Nutritional Deficiency Assessment Questionnaire

 
 Used for both new and existing clients who intend to schedule Nutritional Deficiency Assessment & Supplement Recommendations appointment
   
New Client Form for Product Guidelines  Used for someone with an appointment to receive guidelines and assistance with products previously purchased on HerbManTeas.com
   
Formulario de Evaluacion de Salud del cliente en Espanol

Formulario de Evaluacion Ayurvédica del cliente en Espanol

 

The forms can be completed on a cell phone or computer and can be saved to continue at a later date.


If you haven't already done so, schedule an appointment with Khabir, even if it's just the free 30-minute Zoom appointment.

OR call 888-611-0878 for assistance. 

To discuss your case after completing a form call or text the office at: 1-888-611-0878

You can schedule a FREE 30-minute appointment or an appointment in Ojai, CA, Bulverde, TX, or on Zoom.

Fees


Notice to Texas Residents

If you are located in the State of Texas, please visit www.SouthwickRanch.com for information specific to services provided in Texas, including disclaimers, service descriptions, and legal compliance under Texas law.

Clinic Details

Days & Times

The clinic is available for last-minute appointments; however, an appointment is still required.  Appointments are generally scheduled Monday through Thursday between 10:00 a.m. and 5:00 p.m., and half-day Saturdays, with availability on weekends and evenings upon request.

Family Consultations

Many families find that they share the same health challenges and/or wish to implement lifestyle changes as a family, rather than restricting healthy modifications to a single member. I am happy to consult with families and couples together. Bring your partner or family member to support you!

Payment Policy

Payment for services is required at the time of appointment for office clients or in advance for remote clients (i.e. Skype, email, Google Hangout, phone).  Detailed receipts will be provided by email for all services and products purchased.

Visa, MasterCard and Amex are accepted. PayPal is also accepted. Checks should be payable to Natural Healing Consultants.

Cancellation Policy

Appointments missed or cancelled in less than 24 hours will incur a $50 charge. Exceptions to this policy may be made for emergency situations on a case-by-case basis.

Products

Teas, herbal formulas, supplements, spices, oils and other products are not included in consulting fees or programs unless specifically stated.  We use the highest quality, ethically wildcrafted, pure, and organic herbs in our herbal preparations. * Herbal product costs: Generally, $17.5 for a 2 oz jar; $27 for a 4 oz jar; and $38 for a 6 oz glass jar of powdered herbs; $17.5 or $22 for a 2.5 oz or 3.0 oz bag of loose herbal tea blends; and $17 for 4 oz of herbal oils. Prices are sometimes adjusted based on the cost of the ingredients not the weight.  (Herbal products may be shipped in plastic bags instead of glass jars.)

Insurance

We do not bill insurance directly, but we will prepare a detailed bill that you can submit to your insurance company for reimbursement if your insurance covers naturopathic or nutritional therapy visits.  We do not bill Medicare.


* Privacy

We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information.   Your personal information is contained behind secured networks and is only accessible by a limited number of persons who have special access rights and are required to keep the information confidential. The complete privacy policy.

* Security

All transactions are processed through a gateway provider and are not stored or processed on our servers. Forms (from the links above) are available securely online and managed by Cogniforms.com, which utilizes bank-grade security and proprietary encryption techniques to ensure the highest level of security for your documents and data

 


 

         

Khabir Southwick is available for consultations remotely via Zoom, offering his expertise to clients worldwide.

 Fees and Health Assessment Forms

Call or text 888-611-0878 for more information.  For general inquires: email support @ KhabirsClinic .com

Liability & Educational Use Disclaimer – California Compliance

Khabir Southwick, operating as Khabir’s Clinic, is not a licensed medical doctor, psychologist, psychotherapist, or dietitian. All consultations, services, and content—whether written, spoken, or digital—are provided for educational and informational purposes only, based on traditional natural health systems such as Ayurveda and herbal medicine.

No diagnosis, treatment, or prescription is offered or implied. These services are not a substitute for licensed medical care. Under California Senate Bill 577 (SB-577) and California Business & Professions Code §§2053.5–6, Khabir Southwick lawfully offers alternative health services as an unlicensed practitioner, provided clients are informed of this status.

By using this website or participating in services, you accept full responsibility for your health decisions and agree that no liability shall be held against Khabir Southwick or Khabir’s Clinic.   Complete Disclaimer.  Privacy Policy.

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Contact Info

California Location:
723 Fernando St. Ojai - Business license #8111 Map (by appointment)

Texas Location:

30880 Setting Sun Dr, Bulverde, TX 78163  Map  (by appointment)

Contact Info:
Office: (805) 858-9222

Email:

© 2009-2023 Khabir Southwick