Full Legal Name *

First Name

Last Name

Date of Birth *

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Phone

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What services are you interested in?

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Option 2

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Terms & Conditions *

The Client understands that the role of the Wellness Consultation is not to prescribe or assess specific medical plans; provide healthcare, medical, or nutrition therapy services; or diagnose, treat, or cure any disease, condition, or other physical or mental ailment of the human body. Rather, the Wellness Advisor is a mentor and guide who’s been trained in health coaching and behavioral change to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Wellness Consultation is not acting in the capacity of a doctor, dietitian, nutritionist, psychologist, psychotherapist, or other licensed or registered professional, and that the Program is not intended to replace services performed by these professionals. The Client acknowledges that, if under the care of healthcare professionals, the Client should discuss any dietary changes or potential dietary supplement use with those professionals. If the Client currently uses prescription medications, the Client should not discontinue any prescription medications without first consulting the Client’s prescribing healthcare provider. The Client has chosen to work with the Coach and understands that coaching services, including any information or resources received, are not medical advice nor meant to replace services delivered by licensed health professionals. PERSONAL RESPONSIBILITY AND RELEASE OF HEALTHCARE-RELATED CLAIMS The Client acknowledges that the Client takes full responsibility for the Client’s life and well-being, as well as the lives and well-being of the Client’s family and children (where applicable), and all decisions made during and after the Program. The Client expressly assumes the risks of the Program, including the risks inherent in making dietary and/or lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has, or will have in the future against the Coach, arising from the Client’s past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Coach. CONFIDENTIALITY The Wellness Consultations will keep the Client’s information private and will not share the Client’s information with any third party without the Client’s written consent unless required by law. The Coach will not disclose the Client’s name as a reference or for use in any marketing materials without the Client’s written consent. Cancellation and Rescheduling Policy: - Cancellations made within one week (7 days) of the scheduled appointment or event will be eligible for a full refund. - Cancellations made less than one week (7 days) before the scheduled appointment or event may not be eligible for a refund, depending on the circumstances. Please contact us for further assistance. Rescheduling: - Rescheduling is available up to 72 hours (3 days) before the scheduled appointment or event, subject to availability.

I agree and confirm that I have read through all of the terms and conditions above.