By my signature below, I acknowledge the following and would like to initiate wellness coaching.

• I affirm that I am 18 years of age or older. I understand that participation is voluntary, and I may withdraw at any time by notifying my coach via phone or email. I am aware that sessions will be 60 minutes.
• I am aware that coaching sessions will take place virtually through Zoom or other teleconference method at a day and time that is mutually agreed upon. I understand that I am expected to make all calls on time and will contact my coach at least 24 hours in advance if  unavoidable conflict arises.
• I am aware that I will receive wellness and lifestyle coaching from a Functional Medicine Certified Coach.
• I am aware that coaches are not healthcare providers and coaching does not replace seeing a licensed physician.
• I understand that this coaching relationship is in no way to be considered or construed as psychological counseling or any type of therapy of medical intervention.
• I understand that coaching is its own unique process that draws upon strategies for goal attainment and my coaching results cannot be guaranteed.
• I affirm that I am fully responsible for the choices and decisions in my life and am responsible for my own results.
• I agree that it is my responsibility to tell my coach what works and what does not work, and to be honest about how I would like to be coached.
• I understand that my coach may release me from coaching for any reason, including but not limited to, inappropriate conduct of my doing.
• I agree to hold the coach free of all liability and responsibility for any actions or results for adverse situations created as a direct or indirect result or specific referral or advice given by the coach.

This agreement may be extended or terminated by mutual agreement.

The coaching services provided to me will include a supportive, comprehensive process for attaining wellness and lifestyle goals.

Topics that I may choose to talk about include nutrition, exercise, sleep, stress management, time management, work goals, relationship goals, finding meaning/purpose, and health challenges.

As a client, I understand and agree that I am fully responsible for my well-being during my coaching sessions, including my choices and decisions.

CONFIDENTIALITY: As a matter of ethics, my coach, affirms that she will maintain strict confidentiality about all information shared by me.

The only exception is if my coach has reasonable cause to believe there are threats of serious harm to myself, or others. My coach is then obligated to report the situation to the proper agent.

Your signature on this agreement demonstrates the intent to fulfill the intentions and requests above and reflect a complete understanding of the services provided.