New Client Agreement
 Patient Name:_________________________________Date of Birth___________  Phone number __________________
Welcome. 
As you know, Maggi is a Homeopath and not a licensed physician, nor are her homeopathic services licensed by the 
state of California. It is recommended that you inform your medical doctor that you are receiving Homeopathic treatment.
 THEORY OF HOMEOPATHY 
Homeopathy is a systematic, scientific method of therapeutics that aims to promote health by reinforcing the body's own 
natural healing capacity. The mental, emotional and physical aspects of a person are all very important, and a remedy is 
selected based on the totality of the symptoms expressed in these areas. Improvement in health will be evaluated from a 
total view of all of these areas. In a curative response to a well- selected remedy, there may be a brief intensification of the 
presenting symptoms and/or a temporary return of old symptoms, as the vital force is stimulated to heal.
 NATURE OF SERVICES The Homeopath relies on a good understanding of the patient, therefore, it is important for you to be as thorough as possible
in your consultation. The initial consultation for Classical Homeopathy is approximately 2 hrs. 
Follow up appointments are 15-60 minutes. 
If you must cancel an appointment, please do so at least 24 hours in advance or charges will apply $111. 
Office hours are: 
For Phone and Video calls: Monday, Wednesday, Friday 9:00am-7:00pm 
For House calls in Los Angeles: Saturdays only 5pm-8pm
For House calls in Lake Arrowhead: Monday, Wednesday, Friday 4pm -8pm
Closed Sundays 

MAGGI'S TRAINING AND EDUCATION She is a practicing Homeopath in business, beginning in 2001. Her certification is from The Burren School of Homeopathy (BSHom)
 located in the Republic of Ireland. This qualification is a 4 year, part time, residential program. She was a registered member of 
The Irish Society of Homeopaths (ISHom), the governing body for Homeopathy in Ireland. 2002-2014. This national organization 
promotes high standards of homeopathy by administering a year long appraisal that requires many hours of education, clinical practice,
supervision, a peer review process and extensive knowledge of homeopathy, and the traditional medical sciences. 
Continuing education and Residency in Ireland are required to retain registration status. She moved back to her Native California in 2011.
Her Reiki credentials include completing Reiki 1 in 2002, Reiki 2 in 2005, and her Reiki Masters Training in 2006. 
She is trained in both Tera Mai and Usui styles of Reiki, and has been a practicing professional Reiki Master, since 2006. 
Her Medical Intuitive Training was with Wendy Coulter through The Practical Path and was completed in 2013. 
Her Death Doula training with Sacred Crossings was completed in 2021. 
I understand and agree to Maggi's boundaries when she is in practice at the Homeopathic Pharmacy. 
While I am in private practice with Maggi, I will contact/communicate with her outside Pharmacy hours only. 
I agree to contact Maggi with any questions about my remedy, potency or appointments through her private phone number 
and email listed on this contract. 

AUTHORIZATION OF CONSULTATION I authorize you to discuss my case with other professional homeopaths, should you need assistance in analysis. I understand 
that my best interest will be served by such a consultation. In doing so, my right to privacy will be protected by changing 
or withholding my name and all other identifying information. 
CONFIDENTIALITY I understand that all information disclosed in this consultation is confidential and may not be revealed to anyone without my 
written permission, except where disclosure is required by law. Disclosure may be required in the following circumstances:
 a reasonable suspicion of child or elder abuse, a reasonable suspicion that the client presents a danger to him or herself or to others. 
Disclosure may also be required in relation to a legal proceeding. 

ACKNOWLEDGEMENT OF INFORMATION In order to use my services, California state law requires that you acknowledge receipt of the information provided in this form 
and that you sign it even though my services are not regulated by the State of California.
 ACKNOWLEDGEMENT AND CONSENT TO RECEIVE SERVICES I have read and understand the above disclosure about the Homeopathic/Reiki/ Medical Intuitive etc.. treatment offered by 
Maggi Shanley ISHom BSHom, and I am aware of her training and education. I have discussed with Maggi the nature of the services 
to be provided. I understand that she is not a licensed physician and that Homeopathic/Reiki services are not licensed by the 
state of California. I understand it is my responsibility to maintain a relationship for myself or my family member receiving treatment
with a licensed medical doctor. 
My general practitioner/ Doctor is ___________________________________________________ 
contact phone number ___________________. 
I have consented to use the services offered by Maggi Shanley and agree to be personally responsible for the fees she charges in 
connection with the services provided to me. 
Patient name_________________________________ 
Parent/Guardian if a minor_________________________________________ Date________________________ 

2. Agreement
 Patient Name:______________________________________ 
I have read and agree to the following fee policy. FEE Structure for all services except Classical Homeopathy: $210  - 1 hr.        $170 - 45min
$105 - 30min.     $55 - 15 minutes  (with 15 min minimum for all consults). 
For Classical Homeopathic Treatment: 
This requires a 1.5 hour Initial Consultation for $315 
Homeopathy requires a visit every 6-8 weeks, unless you are in a serious health situation requiring more frequent follow-up appointments. 
House Call - add $55. to standard fees 
Email or Phone calls (in between appointments or Acutes) – $210. per hour with $55. minimum charge Please note that I can not send pellets out to any patient if I have not seen you for a follow up in the last 6 months. 

PAYMENT OPTIONS: ALL OPTIONS TO BE PAID 24 HRS IN ADVANCE. 
BOTH VENMO AND PAYPAL PAYEES CAN FIND MY ACCOUNT BY MY EMAIL OR BY MY PHONE NUMBER, see below.. 
VENMO: No service fee. 
PAYPAL: paypal.me/maggishanley All services paid by PayPal will be charged the PayPal service fee, which is currently 
approximately 4%. Unless you SEND PAYMENT TO FAMILY AND FRIENDS.
 PERSONAL CHECK: to be sent one week in advance to P.O. Box 605, Topanga Ca. 90290 USA
 
Patient signature _____________________________(If client is a child please sign as their parent/guardian ) Date ________________________________ 

Maggishanley@gmail.com
323 608 3605