Online Consultation
& Disclosure Form for
Robert Higgins LMFT, CH

[This information last updated: April 28, 2021].

he purpose of this form is provide essential legal disclosures before providing specific psychological consultations concerning your cancer case. The information you provide will help me do a better job of assisting you. When you submit this form to us, you are acknowledging that you have read this form and you agree with its provisions. Firstly, you should know that I am a licensed, professional psychologist who specializes in working with cancer patients and their psychological issues. I am not a medical doctor. I do not want my consultations to be viewed as a substitute for timely medical advise.
That said, please complete the form below. When finished, click on Send Message at the bottom, and I will contact you upon receipt. If you have any questions, please write to me at: rhiggins@herbhealers.com.

From: (your personal name)
Please enter your email address:
Re-enter email to ensure accuracy:
Please enter your phone number:
Re-enter your phone number to ensure accuracy:
Enter your country, time zone, and best time to call:

Note: You must enter your email address, character perfect, or we will not be able to respond to your email.

Physicalities:
Sex: M F Age:
Height: (inches) or Height: (centimeters)
Weight: (pounds) or Weight: (kilograms)

Current Conditions: -- (In this section, please give me the specifics of your cancer case. Whether you are working with a physician or your case is one of self-diagnosis and/or treatment. Tell me the duration and stage of your condition, psychological issues you may be aware of, and the prognosis for your condition given to you by your primary care physician, if you have it.):



Please enter any amplifying information below that you feel is relevant to my assisting with your case:




Home Consultations :: Email or write to support@herbhealers.com
Sales :: Herbhealers.com (U.S.) Alpha Omega Labs (all other countries)