It is a pleasure to welcome you as a participant to coaching sessions or a programme with Michelle Robinson to help you find healing opportunities to improve your health. During the upcoming weeks and months, you will learn ways to help yourself achieve a healthier lifestyle. It is common practice for naturopaths, nutritionists, and other non-licensed practitioners to collect your signature on a liability waiver form such as this. Please read the following, if anything is unclear, please ask.This Agreement is made between Michelle Robinson( Functional Health Coach/Practitioner) and the Client. The Programme Agreement in which you are about to agree to will/may include all of the following depending on the programme you have purchased:
- Any lab results for kits administered
- Lab Results Worksheets, Report of Findings & Therapeutics Lifestyle Recommendations
- Supplementation Protocol and Supplement Schedule
- Phone and/or in-person consultation sessions to potentially include:
- Questionnaire & History Sessions
- Results reviews
- Coaching sessions with supplements and lifestyle changes
- Any follow up sessions for continued coaching
- Any group coaching sessions, webinars or workshops
- Any Membership access
SCHEDULING I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each coaching session will end within the time it was scheduled. 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 not have an opportunity to reschedule it.
The purchased consultation and/or session(s) expire if sessions have not been initiated within three months after the Purchase Date as indicated on the invoice. In addition, sessions will expire due to inactivity for 3 months once the program has been initiated. If your program is deemed inactive as prescribed and you wish to restart there will be an additional restart fee equal to 10% of your initial program fee.
CONSULTATION PAYMENTS AND REFUNDS Upon commencement of the purchase of the consultation session(s), the full amount of the invoice is due and must be paid in full. However, in order to help the Client afford this Program, the Client may pay 2-3 payment on credit/debit card In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain fully responsible for the unpaid balance of the consultation(s). Under no circumstance will the Practitioner refund any payments made by the Client. With payment of the first consultation session this Agreement will commence, the Client agrees to be legally obligated to pay the full amount of all consultation sessions agreed upon.
What we do and do not do
We obtain a set of laboratory test results from a [ Certified Laboratory in the United States or Certified labatory in Europe] and provide you with a nutritional interpretation of those test results that you can use exclusively as an educational tool for personal health purposes.
Your doctor may use the same test results to diagnose and treat disease, but we do not do this. The information we provide is not intended to, cannot, and should not be expected to be a substitute for a personal consultation with your own qualified doctor. We do not accept any liability for any failure to identify any medical condition or disease; this is not the purpose of our services.
We may provide you with information relating to products that we believe might benefit you, but such information is not to be taken as an endorsement or recommendation. Some such products may not be available without a prescription, but we do not dispense or prescribe any prescription products. The information provided is intended for educational purposes only and should not be taken as professional medical advice or used as a substitute for medical care. We are not responsible for any adverse affects or consequences that may result, either directly or indirectly, from that information.
We will make reasonable effort to protect the privacy of your medical information that is shared with us, including any medical test results. If you make a mistake collecting saliva or urine specimens, etc., or if the lab refuses to accept specimens because of a mistake you made, a free replacement test kit will be provided to you. Please email Michelle before discarding any specimens collected. Otherwise, once test kits are in your possession, they may not be returned and no refunds are allowed for any test kits due to safety, hygiene and accuracy concerns.
Consult your doctor
We are not qualified medical advisors and make no claims to be so. The information we provide should not be taken to be, and is not a substitute for, personal medical advice and instruction. You should not take any action based solely on our advice.
You should consult your doctor:
- for any medical interpretation of your test results;
- on any matter relating to your health and well-being;
- before making any changes to your exercise or diet;
- before taking any nutritional, herbal, homeopathic or hormonal supplementation;
- before beginning any therapy.
The Practitioner encourages the Client to continue to visit and to be treated by his/her healthcare professionals, including, without limitation, a Doctors physician. The Client understands that the Practitioner is not acting in the capacity of a doctor, licensed dietitian, psychologist or other licensed or registered professional. Accordingly, the client understands that the Practitioner is not providing health care, or medical care and will not diagnose, treat or cure in any manner whatsoever any disease, condition or other physical or mental ailment of the human body.
The Client has chosen to work with the Practitioner and understands that the information received should not be seen as medical or nursing advice and is certainly not meant to take the place of your seeing licensed health professionals.
It is your responsibility to deliver all laboratory test results, now and in the future, to your own physician for any medical interpretation or opinion regarding any laboratory results provided by The Practitioner or his/her affiliates. The undersigned agrees that he or she will receive a nutritional interpretation of the test results from The Practitioner that is to be used exclusively by the undersigned as an educational tool for personal health purposes. However, the personal physician of the undersigned may use these same laboratory results to diagnose and treat disease. The information on The Practitioner’ web sites, brochures, flyers, and information packets are believed to be extremely accurate, but such accuracy cannot be guaranteed by The Practitioner, his/her independent representatives, associates and affiliates as we are not the originators of the underlying data used in the interpretation. The undersigned releases The Practitioner from any liability for injury or loss arising out of the use of, or reliance on, the laboratory results and/or the dietary, supplement and lifestyle suggestions provided. Before making any changes to the exercise, diet or nutritional or hormonal supplementation of the undersigned, a physician should be consulted.
The Practitioner does not diagnose, cure or treat any illness or disease. Out of reference laboratory reference range results will be indicated on the official lab result form provided by The Practitioner from a State Certified Laboratory to the undersigned. This information is not intended to, cannot, and should not be expected to substitute for a personal consultation with your own physician. Further, the undersigned releases The Practitioner, his/her lab partners, his/her independent representatives, associates and affiliates from any and all liability for any failure to identify any medical condition or disease. It is understood and agreed that this is not the purpose of their services.
PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE 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 afterExclusion of warranties
We will provide our services to you with reasonable care and skill. But we make no other warranty, express or implied, with respect to those services. All other warranties are excluded to the maximum extent permitted by law.
We make no warranty as to the accuracy of the laboratory test results we receive.
We make no warranty, expressed or implied, as to the quality or effectiveness of any diagnosis, apparatus, treatment or product. In no event will we be liable for any physical or mental injury, or any negative side effects, that may arise from the use of any such diagnosis, apparatus, treatment or product.
We believe that the information we provide, including that on our web sites, brochures, flyers and information packets, is accurate, but we cannot guarantee such accuracy. We therefore make no warranty as to the accuracy of that information, and it should not be relied upon as being correct, complete or accurate. It is your responsibility to verify such matters independently from primary sources of information and by taking specific professional advice.
Exclusion of liability
If you rely on, buy or use a product or therapy, you do so at your own risk. Each person is different, and the way someone reacts to a product or therapy may be significantly different from another. We cannot predict how you may react to any particular product or therapy.
To the maximum extent permitted by law, we exclude:
- any and all liability in contract, tort (including negligence), breach of statutory duty or otherwise for any direct, indirect, special, incidental, or consequential costs, losses, claims, damages, expenses or proceedings (including but not limited to loss of profits and wasted management time) incurred or suffered by you arising directly or indirectly out of or in connection with our services, including but not limited to any loss, damage or expense arising from any defect, error, imperfection, fault, mistake or inaccuracy with the information or advice we provide;
- any and all liability for injury or loss arising out of the use of, or reliance on, the laboratory results and/or the dietary, supplement and lifestyle suggestions we may provide;
- any and all liability for injury or loss arising from any product or treatment you may choose to take;
- any and all liability for any failure to identify any medical condition or disease. You understand and agree that this is not the purpose of our services.
This is a comprehensive limitation of liability that applies to all damages of any kind, including (without limitation) compensatory, direct, indirect or consequential damages, loss of data, income or profit, loss of or damage to property and claims of third parties.
No recommendation All material and information we may provide about products and therapies is provided solely for educational purposes and for use when discussing your health with your doctor. By providing you with such material and information, we do not necessarily endorse, recommend or promote any such product or therapy.
Client acknowledges that during the course of performing contracted services for the Client, the Practitioner may send health information electronically via email or other sources that may not be secure.
Michelle Robinson (Practitioner) acknowledges that during the course of performing contracted services for the Client, the Practitioner may have access to, use, or disclose confidential health information. Practitioner hereby agrees to handle such information in a confidential manner at all times while providing services for the Client and after the services are completed, and commits to the following obligations:
- Practitioner will use and disclose confidential health information only in connection with and for the purpose of performing services.
- Practitioner will request, obtain, or communicate confidential health information only as necessary to perform services and shall refrain from requesting, obtaining, or communicating more confidential health information than is necessary to accomplish services.
- Practitioner will take reasonable care to properly secure confidential health information on any computer and will take steps to ensure that others cannot view or access such information. When away from workstations or when tasks are completed, Practitioner will log off computers or use a password-protected screensaver in order to prevent access by unauthorised users.
- Practitioner will not disclose personal password(s) to anyone without the express written permission of the Client, or record, or post it in an accessible location and will refrain from performing any tasks using another's password.
By signing my full name below I agree to all the terms and conditions within this document:
Date of Signature: