Integrative Health Practitioner Client Agreement & Disclaimer
Before beginning Integrative Health Coaching and Functional Lab Analysis, please read the following carefully, then sign and date. For the purposes of this disclaimer, Functional Lab Analysis is included within Integrative Health Coaching.
🌿 INTEGRATIVE HEALTH GOALS
The goal of Integrative Health & Functional Nutrition is to empower you with knowledge about your body and provide a science-based, holistic approach to health. As an Integrative Health Practitioner (IHP), my role is to support your body's natural healing processes through:
✔ Gut Health & Digestion – The foundation of nutrient absorption and overall wellness
✔ Blood Sugar Regulation – Balancing energy and hormone function
✔ Fatty Acid & Inflammation Balance – Supporting cellular health and immune function
✔ Mineral Balance – Ensuring optimal metabolic and hormonal function
✔ Detoxification & Hydration – Optimizing elimination pathways for cellular renewal
By addressing these core areas and adopting a bio-individual approach to nutrition and lifestyle, your body can restore balance naturally.
However, this work is not intended to diagnose, treat, or cure any disease. As an Integrative Health Practitioner, I do not prescribe medications. Instead, I evaluate underlying imbalances and recommend lifestyle changes, targeted supplementation, and functional nutrition strategies.
Achieving lasting results requires commitment, consistency, and an open mind. If you are unwilling to make adjustments to your diet, lifestyle, and habits, this approach may not be the right fit for you. Because each individual is unique, I cannot guarantee specific outcomes.
⚕️ HEALTH CONCERNS & MEDICAL DISCLAIMER
If you have a diagnosed medical condition or require medical treatment, you must consult your healthcare provider. I am not a substitute for your physician or licensed medical provider.
✔ If you are under the care of a doctor, it is your responsibility to inform them of any dietary or supplement changes.
✔ If you take prescription medication, consult your doctor or pharmacist about any potential interactions with supplements.
✔ If you experience a reaction to any suggested protocol, discontinue immediately and contact me to determine whether it is an adjustment response or an adverse reaction.
Functional lab testing, nutrition, and lifestyle changes can be a beneficial complement to conventional healthcare, but they do not replace medical treatment.
📌 CLIENT RESPONSIBILITIES & PREPARATION
Your health transformation is a partnership. To ensure the most effective and personalized experience, I require four key inputs before we begin your customized 12-week plan:
1️⃣ Complete the Client Intake Form – Provides health history & lifestyle factors
2️⃣ Fill out the Nutritional Assessment Questionnaire (NAQ) – Identifies symptom patterns & imbalances
3️⃣ Track Your Food Journal – Gives insight into diet, digestion, and metabolic health
4️⃣ Complete the HTMA (Hair Tissue Mineral Analysis) Test – Reveals mineral status, metabolism, & stress levels
These four components work together to give us a complete picture of your health. Your HTMA results will show what’s happening at a biochemical level, while your intake form, NAQ, and food journal will help us connect those imbalances to real-life symptoms.
💡 Every client’s journey is unique. Some may see significant improvements with these adjustments alone, while others may require additional testing, structure, or accountability. This is why we start here—to ensure your plan is based on YOUR body’s needs.
📞 COMMUNICATION & PROGRAM ADJUSTMENTS
Because no two bodies are alike, your protocol may need adjustments as we work together. As we fine-tune your nutrition, lifestyle, and supplement strategy, your active participation is essential.
To get the most out of this process, you agree to:
✔ Follow the recommendations given to the best of your ability
✔ Avoid harmful foods, substances, or habits that interfere with progress
✔ Incorporate movement, stress management, and proper rest
✔ Communicate openly so adjustments can be made as needed
Results are not instantaneous. Healing takes time, consistency, and commitment. Regular check-ins and adjustments ensure you stay on the right track toward optimal health.
🔒 PRIVACY & CLIENT CONFIDENTIALITY
During our work together, I may collect personal health information, including but not limited to:
Your name, contact information, and date of birth
Your health history, symptoms, medications, and supplements
Your lifestyle habits and dietary patterns
Your privacy is important to me. While Integrative Health Practitioners are not classified as HIPAA-covered entities, I adhere to strict confidentiality standards and best practices to safeguard your information.
✔ Your data will never be shared without your written consent.
✔ All stored information is protected with secure passwords and encrypted devices.
✔ Physical documents are kept in locked storage.
While I take every precaution to ensure your information remains private, no system is 100% immune to data breaches or unauthorized access. By signing this document, you acknowledge that you understand the privacy measures in place.
📜 INFORMED CONSENT & AGREEMENT
By signing below, you acknowledge and agree to the following:
✔ I understand that Integrative Health Coaching & Functional Nutrition do not replace medical care.
✔ I acknowledge that this program is not intended to diagnose, treat, or cure any condition.
✔ I take full responsibility for my health decisions and will consult my physician as needed.
✔ I consent to providing personal health information for assessment and program recommendations.
✔ I understand that results may vary, and success depends on my consistency and participation.
🖊 SIGNATURE REQUIRED
I, [Client Name], confirm that I have read and understand this disclaimer, and I freely consent to participate in Integrative Health Coaching with full awareness of its scope and limitations.