Nutrition and Wellness Coaching Consent Form
1. Disclaimers
1.1 I understand that Maria Angeles Diaz, a Degreed Functional Nutritionist, does not dispense medical advice or prescribe treatment. Rather, she provides education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviors associated with eating. While nutritional and botanical support can be an important complement to medical care, I understand that nutrition counseling is not a substitute for diagnosis, treatment, or care of disease by a medical provider.
1.2 If I am under the care of a healthcare professional or currently use prescription medications, I will discuss any dietary changes or potential dietary supplement use with my primary care physician and will not discontinue any prescription medications without first consulting my primary care physician.
1.3 I acknowledge that the care I receive during nutrition and health coaching sessions is separate from the care I receive from any medical facility. Nutrition coaching sessions are in no way intended to be construed as medical advice or care. I will continue regular medical supervision and care by my primary care physician.
2. Personal Responsibility and Release of Health Care Related Claims
2.1 I take full responsibility for my life and well-being, as well as the lives and well-being of my family and children (where applicable), and all decisions made during and after the duration of my nutrition and wellness coaching sessions.
2.2 I expressly assume 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 I release Maria Angeles Diaz, Vitale Life and Human Vitale from any and all liability, damages, causes of action, allegations, suits, sums of money, claims, and demands whatsoever, in law or equity, which I ever had, now have, or will have in the future against the Nutrition Wellness Coach, arising from my past or future participation in, or otherwise with respect to, the nutrition sessions, unless arising from the gross negligence of the Dietitian/Nutritionist.
3. Confidentiality
3.1 The Nutritionist will keep my information private and will not share it with any third party unless compelled to do so by law or with my consent.
4. Payments and Refunds
4.1 Payments are due at the time of service, and there are no refunds for payments made to Vitale Life, Human Vitale or Maria Diaz
5. No-Show/Cancellation Policy
5.1 In the event that I do not show up to an appointment or cancel within 48 hours of a scheduled appointment, Vitale Life or Human Vitale or Maria Diaz reserve the right to charge me 50% of the session payment fee, in case I pay per session: if I paid for the 10 session program or other type of session package, the session will be taken as given and the program, homework and or support material of that session will be send to me by email or direct message to my cellphone.