Please complete this form to request sliding-scale herbal medicine treatment

everyone deserves access to well-rounded, informed, and non-predatory alternative treatment. Healthcare in all its forms is a human right. Full stop.

We operate sliding scale treatment as a community service. Please understand that spots are limited and you may be placed on a waitlist should we be at financial capacity for this type of service.

Name

First Name

Last Name

Email

What is your primary concern that brought you here?

Select all that apply

Mental Health Management

Hormonal Regulation

Gut/Digestion Support

Skin Issues

Fertility

Other

Is there anything else you'd like me to know before we consult?

Range of financial capacity

By checking this box you acknowledge that Bailey is not a medical doctor and cannot diagnose, treat, or cure any disease. The information and products provided are not regulated by the FDA. You understand that you may be referred to a medical doctor should your concerns be out of our scope of practice, and you accept full responsibility for your safety and healthcare. Should you be in crisis or experiencing an emergency, you will contact your primary care physician or 911.

I Understand