Intake forms, Directions, and Cancellation Policy

​Jane Smolnik, N.D., Iridologist, C.I.H., M.H.
Phone 828-777-JANE (5263)   drjanesmolnik@gmail.com   www.UltimateHealing.com

 

Please click on our ONLINE INTAKE FORMS, fill out 24 hours before our appointment to save us both time and money.

Or if you prefer, you can print the intake forms above and bring with you at the time of your appointment.  

For all PHONE consultations - please use the BioChemistry Questions form below:

 

 

Direct Links to: 

Page 1

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Page 3

Feel free to call 828-777-5263 if you have any questions.  You can also print out directions to my office here. 

 

CANCELLATION POLICY - Please read!

 

You may cancel or change your appointment time up to 24 hours in advance.  Last minute changes or 'no-shows' will be responsible for HALF the fee for the service time scheduled (unless that time can be filled). 

Payment is expected at time of service by either cash, check or credit card.  

We like to be prompt to respect your time scheduled as well as ours.  Please be prompt since this is the only time allotted for you.  If you are late, you will be missing part of your appointment.  

 

DIRECTIONS  

             Ultimate Healing Office

4 Olde Eastwood Village Blvd. Suite 207-C

Asheville, NC 28803

DIRECTIONS:

 

DIRECTIONS:

From I-40, take Exit 53-A, Rt. 74-A towards Fairview, Blue Ridge

Parkway, Bat Cave

From I-240 east, take Exit 9, Rt. 74-A towards Blue Ridge Pkwy.,

Bat Cave.

Head south, go to the 4th traffic light directly across from Ingles and

CVS, (just past Reynold’s High School)

Turn LEFT at the light, pull into Eastwood Village, you can park

anywhere, and there’s an extra lot to the left.

Enter at the center glass door to the RIGHT of ‘Great Wall’ Chinese

Restaurant. Go up the stairs and you will see a comfortable waiting

area. I will be with you shortly.

Please Call if you have any questions. Ph: 828-777-5263

 CLIENT INFORMED CONSENT & STATEMENT OF INTENT

I, Jane Smolnik, am a Traditional Naturopath and Iridologist. I hold a doctorate in Natural Medicine from Trinity College of Natural Health, I am a Diplomat in Holistic Iridology, Certified in Comprehensive Iridology, a Master Herbalist, a Certified Holistic/Spiritual Healer, and certified Instructor for Solas Academy. I have worked consistently in the field of nutrition and health education since 1990. I am a Health Educator/Coach, NOT A LICENSED PHYSICIAN. As such, I do not diagnose or treat disease, nor do I recognize disease. I also cannot and will not tell you not to take a medication your doctor has prescribed but we can discuss it. Rather, I help educate you and support the innate healing response of the body through food, nutrition, relaxation & visualization, herbs and supplements, nutritional balancing, energy/light/vibrational therapies, and stress reduction. 

I, the Client, understand that information provided on the relationship between nutrition and health is NOT meant to replace competent medical care or treatment for any health problem or condition. I understand that a Comprehensive Assessment and Health Evaluation are not done to define health as it relates to disease, but as it relates to wellness. 

I fully understand that the attending practitioner does not offer allopathic drugs, surgery, chemical stimulants, radiation therapy or any other conventional treatments. In addition, he/she does not diagnose, treat or otherwise prescribe for my disease, conditions or illness. I am advised to see my licensed healthcare provider for medical care. 

I, the Client, choose to improve my health by assuming greater self-responsibility to reduce or eliminate unhealthy behaviors that are contrary to my well-being. I am here to educate myself on how to take better care of my body naturally for greater health. 

I certify that I am here solely on my own behalf. I am not representing any other person, company, association, and/or on the behalf of any governmental agency. 

I currently am___ /am not____ under the care of a physician for a health problem or medical condition. If so, for what problem or condition? 

My physician is: ________________________________________________________________________________ 

                      (You will be asked to sign this informed consent form as part of your intake forms.)

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PLEASE NOTE:  The products and the claims made about specific products on or through this site have not been evaluated by the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. The information provided on this site is opinion only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or health regimen.

 

Copyright 2018  Ultimate Healing, Jane Smolnik, Asheville, NC  Do NOT use or copy any information without written permission.