Nutrition and Wellness Coaching Consent Form
1.1 I understand that Dr. Janine Mahon is a doctor of Chinese Medicine and does not dispense. Western medical advice nor prescribe Western treatment. Rather, she provides education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviors associated with overall health. While nutritional and botanical support can be an important complement to my medical care, I understand nutrition counseling is not a substitute for diagnosis, treatment, or care of disease by a medical provider.
1.2 If the Client is under the care of a healthcare professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplement use with his or her primary care physician, and should not discontinue any prescription medications without first consulting his or her primary care physician.
1.3 The Client acknowledges that the care that they receive during their nutrition and health coaching sessions is separate from the care that they receive from any medical facility in that the nutrition coaching session are in no way intended to be construed as medical advice or care. The client should continue regular medical supervision and care by their primary care physician.
2. Personal Responsibility and Release of Health Care Related Claims
2.1 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 duration of the client’s nutrition and wellness coaching sessions.
2.2 The Client expressly assumes the risks of nutrition and wellness coaching sessions, including the risks of trying new foods, and the risks inherent in making lifestyle changes.
2.3 The Client releases Dr. Janine Mahon from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in lay or equity, which the Client ever had, now has or will have in the future against Dr. Janine Mahon, arising from the Client’s past or future participation in, or otherwise with respect to, the nutrition sessions, unless arising from the gross negligence of the health and wellness coach.
3.1 Dr. Janine Mahon will keep the Client’s information private, and will not share the Client’s information to a third party unless compelled to do so by law or with the consent of the Client.
4. Payments and Refunds
4.1 Payments are due at the time of service and there are no refunds for payments made to Dr. Janine Mahon.
5. No-Show/Cancellation Policy
5.1 In the event that the Client does not show up to an appointment or cancels within 24 hours of a scheduled appointment the client is responsible for 100% of the session fee.
5.2 The above may be disregarded in the event of an emergency.