1. I hereby authorize Embody Vitality Health and Wellness llc to use the telehealth practice platform for telecommunication for therapeutic wellness coaching. Virtual sessions will be done primarily using doxy.me which is a HIPAA compliant telemedicine platform (Zoom may be an alternative).

2. I understand that technical difficulties may occur before or during the telehealth sessions.

3. I accept that the professionals can have interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.

4. I agree that my information on telehealth can be kept for further assessment and analysis, and in all of these, my information will be kept private.

5. I will ensure that I am in a quiet private location for all my sessions.

6. I understand to maximize the usefulness of my session punctuality is important. I will be financially responsible for the full length of time that I am scheduled.

7. I understand that 24 hours notice is required to cancel an appointment. The cost of the session will be my responsibility if less notice is provided. I understand that in the event the provider has to cancel your appointment she will reschedule within that same week and will offer a complimentary 20 min appointment that can be used at a later date.

8. I understand that all information will be kept confidential.

9. I agree to all the information listed above and consent to receive therapeutic wellness coaching services from Embody Vitality Health and Wellness llc.