Disclaimers
The Client understands that the role of the Health Coach is not to prescribe or assess micro-and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands the Coach is not acting in the capacity or doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take place of advice by these professions. The Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor.
The Client has chosen to work with the Coach and understands that the information received should not be seen as medical or nursing advice and is not meant to take the place of seeing licensed health professionals.
Personal Responsibility And Release Of Health Care Related Claims
The Client expressly assumes the risks of the Program, including risks of trying new foods or supplements, and the risks inherent in making 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 Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled by law.
Client name___________________ Signature __________________________Date _____________
Coach name___________________Signature___________________________Date______________
Informed Consent For Firefly Therapy
Firefly therapy utilizes packets of light called Photons to stimulate blood circulation to the treatment area. This results in relief of pain and reduction of symptoms associated with soft tissue injury, such as swelling. Firefly therapy also decreases the healing time associated with superficial injuries, such as burns, cuts and contusions.
Adverse effects from Firefly therapy are normally rare and temporary. These effects may include from multiple sources, in most cases involving a hypersensitivity to light, preexisting medical condition, thermal effects, excessive pressure from the treatment unit, and over-stimulation.
Firefly therapy can cause serious damage to the eye, therefore it is very important to wear protective glasses that will be provided at all times during treatment.
Although rare, the most common adverse effects to Firefly therapy are:
I have read and understand the risks of Firefly therapy. I agree to wear protective glasses provided to me at all times during treatment.
Signature___________________________________Date______________________
Printed name____________________________________
Date of Birth_____________________________________
Preventative Health Pathway
Program Agreement
Welcome to Preventative Health Pathway. During the next months, you will learn ways to help yourself achieve possible improved cognition, a healthier diet and lifestyle. Please read the following. If anything is unclear, please ask.
This Agreement is made today between the Coach of the Program and the person named at the end of the document, {the Client}.
The Program in which you are about to enroll in will include all the following:
Initial two visits up to two hours to get to know the client and their needs. This purpose will be to set up an individualized plan. It will include going over health history, medications, lifestyle choices and what food is in their pantry and refrigerator.
One 50-minute face to face or Zoom meeting each month for the length of the program. This will include a discussion of your progress, recommendations, and a full set of notes.
Email, text or phone calls(no longer than 15 minutes) are included for any questions, correspondence and encouragement that is needed for each individual.
Scheduling
As your coach, I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. The first two sessions can last up to one and one-half hours. The following monthly sessions will end 50 minutes after it was scheduled to begin. Please be on time. If the Client needs to cancel or reschedule the appointment, the Client must do so 24 hours in advance; otherwise, the Client will forfeit that appointment and will not have an opportunity to reschedule it.
Program begins and ends (“End date”)
This program expires if all sessions have not been completed within two months after the End Date specified above.