Custom Wellness Tea Blend Consultation Intake Form-AFRIKAN GODDESS LAIR LLC Logo
  • Custom Wellness Tea Blend Consultation Intake Form

    Provided by Afrikan Goddess Lair, LLC
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  • RENDER COACHING SERVICES AGREEMENT

    1. Parties
    This COACHING CONTRACT (“Contract”), dated * , is made by and between Afrikan Goddess Lair, with an address of 304 E. Pine Street, Ste 1167 Lakeland, FL 33810 (“Coach”), and *. In consideration of the mutual promises and covenants in this Contract, of which the receipt and sufficiency are hereby acknowledged, the parties further agree to the terms as follows:
     
    2. Services
    The Coach agrees to provide Wellness Coaching Services (“Services”) to the Client in preparation for the Client to achieve the health related goals and results the client seeks. The client enters into the coaching agreement with the understanding that the Client is responsible for creating their own results as it is the responsibility of the Coach to help the Client achieve the health related goals and results the Client seeks.
    The Services include but are not limited to:
    *Preparation of customized herbal blends
    *Biweekly check in via Zoom or phone call
    *Guidance and coaching through the detoxing/cleansing process
    *Uplifting Affirmations to recite daily during your journey
    *Fitness and movement plan
    *Preparation of customize alkaline plant based meal
     
    3. Responsibilities
    Client
    It is expressly understood that it is the Client’s responsibility to follow the strict guidance of the Coach without any variance. The Coach is bound to the responsibilities given to the Coach if and only if the Client adheres to the Client’s responsibility. A separate and explicit responsibilities addenda will be given to the Client that will be bound and enforced in accordance to this Contract.
     
    Coach
    It is expressly understood that it is the Coach’s responsibility to follow the strict guidance of the Coach’s responsibilities addenda without any variance. The Coach is bound to the responsibilities given to the Coach if and only if the Client adheres to the Client’s responsibility. A separate and explicit responsibilities addenda will be given to the Client that will outline the given responsibilities of the Coach to be bound and enforced in accordance to this Contract.
     
    4. Term
    This Contract will be effective on and will continue until 11:59pm on . The Contract may be terminated earlier by either of the Parties involved for any reasons determined valid by both Parties with at least 15 day notice and may also be extended with prior notice of at least fifteen (15) days.
    5. Payments
    Payments are due within 24 hours of contract execution. There is a three (3) day grace period for payment to be received. If payment is not received by 12p on the fourth day, there will be a $100 late fee. If full payment or balance of payment is not received by the 15th day after contract execution, Afrikan Goddess Lair will submit delinquent accounts to a professional collection agency. Payments may be rendered by cash, cashier’s check, money order, debit card, credit card, Zelle® transfer, CashApp® transfer. No refunds will be given. Client is responsible for all Afrikan Goddess Lair’s service fees and any additional expenses incurred on behalf of Client including but not limited to delivery fees and notary services. This agreement will be considered breached if any payment is returned by a financial institution or not received by its due date and full action will be taken by Afrikan Goddess Lair to receive payment or balance of payment.
     
    6. Transparency
    The Client is encouraged to be transparent to the Coach in the coaching sessions, and the Coach is expected to diligently provide appropriate Services corresponding to the topic brought up and about by the Client in the coaching session.
     
    7. Non-Disclosure And Intellectual Property
    The Client and the Coach shall not disclose to any third party any and all information relayed and discussed during each coaching session unless disclosure is reasonably required. Such reasonable disclosure shall be subject to the prior written approval and consent from the other party. Coach shall be solely and exclusively entitled to any right, title, and interest in and to all or any intellectual property generated in its performance of this Agreement, including but not limited to copyrights, patents, know-how, trade secrets and the like. Client shall not attempt to copy, duplicate or otherwise distribute these intellectual property.
     
    8. Confidentiality
    Due to the medical and personal nature of the Coach’s services, the Coach WILL NOT disclose any personal information to any third parties, including other medical personnel, without the explicit and written permission of the Client. This written consent must be legally notarized and delivered to Coach via mail and/or a secure online channel.
     
    9. Entire Contract
    This Contract constitutes the entire and final agreement between the Coach and the Client and will supersede any other prior agreements or contracts.

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  • INFORMED CONSENT, WAIVER, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK FORM

    Below is a legal waiver between the Practitioner and the client stating that the client will not sue the Practitioner in the event that something undesired occurs. Filling out this waiver is required to receive products or services from the Practitioner.
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  • Thank you so much for all the information. This is the end of the client intake form. Please mark submit below to send this information to your Practitioner.
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