• Client Intake

    Hi there! I'm Suzanne Geraci and I'm so glad to see you here! Payment info for "Spring Into Food Freedom" is at the bottom of this form. Thanks for completing all required fields...the more I know, the more I can help!
  • Health History

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  • Lifestyle Questions

  • Privacy & Confidential Information

  • Health Notice/Terms & Conditions

  • White Peacock Wellness (“WPW”) is a Florida Limited Liability Company providing motivational coaching and accountability services to individuals following the Whole30 -program.  Florida law allows only licensed dieticians and nutritionists to provide nutritional advice or counseling for pay.  White Peacock Wellness, its owners and employees are not licensed medical professionals and do not provide nutritional advice or counseling.  The Whole30 program suggestions and guidelines are intended to promote general health and wellness, and your WPW coach provides motivation and accountability for those who have chosen to follow the Whole30 program.  Whole30 does not replace physician care or medical intervention and no statements made by WPW diagnose, treat, or cure any disease or ailment.  WPW will help you through the program with our knowledge and experience of the Whole30.  Therefore, if you have any issue not covered by the Whole30 website, Whole30 books or additional resources you will be asked to make an appointment with a licensed medical professional.  You agree to review the Whole30 program with a licensed medical professional before beginning the Whole30 program.  As with any program, inherent risks may exist relative to your state of health, wellness, fitness, awareness, and personal situation.  It is your responsibility to disclose any information that may limit your participation in the Whole30 program.  It is your responsibility to seek clarification of guidelines and recommendations from WPW when not clear to you.  Individual results and changes in general health and wellness may vary depending on medical conditions, medications, and adherence to the Whole30 program.  Your physician prescribed medications may require modification while on the Whole30 program; it is your sole responsibility to discuss this with your physician.  Never reduce or eliminate physician prescribed medications without the direction of your physician or medical provider.  Your personal health information will remain confidential and WPW will not share your personal health information without your consent.  WPW reserves the right to refuse services to any individual or to refer participants to appropriate medical professionals.

    I hereby acknowledge that I have read and understand the above disclosures regarding the Whole30 motivation and accountability services offered by WPW.  WPW has sufficiently explained to me the nature of their services and I understand and agree to the following:

    •      that WPW and its employees are not physicians or licensed medical providers, or Registered Dieticians or licensed Nutrition Counselors;

    •      that Whole30 coaching services are not licensed by the State, medically authorized, or sponsored by any licensing bodies;

    •      that it is my responsibility to maintain a relationship with a physician or other licensed health provider;

    •      that I have checked with my physician or licensed health provider and he/she has recommended I follow the Whole30 program;

    •      that my success on Whole30 is dependent upon my adherence to the program and WPW makes no promises or guarantees as to my individual results while on the Program;

    •      that I have consented to use the services offered by WPW and agree to be held personally responsible for the fees in connection with the services provided to me

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  • Thank you for taking the time to fill this out! Feel free to call or text me if you have any questions - 802-343-5626 or you can email me at suzanne@wpwellness.net.

  • Current Offerings

  • I accept payment via Venmo and Paypal. Please contact me if you need to arrange another form of payment at 802-343-5626 or suzanne@wpwellness.net

  • Venmo "handle" - @SuzanneGeraciWPW

  • Paypal email id - PayPal.Me/wpwellness

  • Thank you for your payment. I will be in touch with you soon. Suzanne.

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