Please note that this form must be signed prior to your first appointment.
Rebecca Harder will perform a basic assessment to determine your detox and cleanse needs for health coaching.
This consultation may identify specific health needs or provide needed education about nutrition, personalized wholefoods and dietary recommendations, meal plans, lifestyle modifications, weight loss or detoxification programs advice about exercise and coaching about lifestyle changes supporting greater health and function. Recommendations may include herbal and nutritional supplement such as vitamins, minerals, herbs, amino acids and fatty acids.
I understand that Rebecca Harder (Gastra Girl Holistic Health Coach) does not function as a medical physician, a licensed nutritionist, psychologist, counselor or other licensed practitioner. If I have not already done so, I agree to consult a medical doctor for any serious or life-threatening disease conditions, either for myself or someone under my guardianship.
I understand that no suggestions are being made for me to discontinue any treatment being provided by any other health care professional. It is important that I maintain regular visits with my primary care physician and medical specialists as appropriate, to ensure proper medical care.
Rebecca Harder is not a medical doctor or other licensed health care professional. Consultations are not a substitute for medical care and do not include diagnosing or treating disease. Educational consultations in nutrition can serve as an excellent adjunct to a medical doctor’s treatment and are intended to expand a client’s consideration of available options and are intended to assist with compliance with any medical care a client may be receiving as well as assist in the use of natural means to support health.
No aspect of a consultation should be understood as a basis to avoid any diagnostic work-up or discontinue any medical treatment. Clients should follow-up with their physician to discuss any modifications they intend to make to their health protocols, to evaluate any testing results or to change protocols as necessary.
In appropriate cases, Rebecca Harder may make suggestions for herbal or nutritional supplements. These interventions are provided to support wellness. Some of the nutritional, herbal and other methods suggested by Rebecca Harder are considered to be complementary, alternative, or holistic care, and may not be accepted by the larger community of medical physicians. You assume all financial, mental or physical risk for undergoing any cleanse or taking any supplement or doing any modality Rebecca Harder suggests. There are always risks to anything in life and the client assumes all risk.
Rebecca Harder provides non-medical food consultation/coaching, which can include education about nutrition, personalized whole foods suggestions, recipes, cleanse programs and shopping lists, lifestyle modifications, suggestions about exercise and coaching about lifestyle changes supporting greater health and function. Recommendations may include herbal and nutritional supplement such as vitamins, minerals, herbs, amino acids and fatty acids.
Rebecca Harder is not a licensed dietician or nutritionist nor does she provide any of these services.
Health coaching educates, encourages and organizes wellness. Rebecca Harder supports clients who wish to cultivate positive and healthy lifestyles. The coaching relationship assists clients develop understand their needs, develop health goals identified by the client or by their physician or other licensed professional. The coach provides education and encouragement about health options the client can explore with their physician, other health professional or on their own as appropriate. Coaching encourages self-health management to assist clients formulate their health goals and devise and follow strategies to implement lifestyle and behaviorchanges. Health Coaching and educating about healthy choices and available resources is tailored to a client’s particular needs so that they may make informed choices about their health options. Choices are driven by the client’s perception of their needs and any health goals. Coaching offers support; questions regarding the diagnosis or treatment of any health or nutritional condition should be directed to the client’s physician, nutritionist or other health care professional.
Rebecca Harder is a National Board Certified Colon Hydrotherapist and IACT Instructor, graduating in 2003.
She has performed over 20,000 consultations and colon hydrotherapy sessions and is the owner of Colon Care, LLC in Portland, Oregon.
Before beginning any exercise program, clients with medical conditions or who have not exercised in some time should obtain medical clearance before beginning any exercise program. Exercise programs always contain some risk of injury or trauma if done incorrectly, in excess, or because of underlying medical conditions.
Notices to Pregnant Women: All female clients must alert Rebecca Harder if they are pregnant or breastfeeding or suspect they could become pregnant to enhance the safety of any lifestyle changes, nutritional and herbal product recommendations and to allow any appropriate referrals can be considered.
No Guarantees: Like any effort to improve health, consulting is an art as well as a science. No guarantees are made that a client will gain any benefit or not suffer any adverse consequences.
Like many interventions, some nutritional and natural remedies may not have not been subjected to rigorous scientific study and there are wide individual differences in responses to these services. The responsibility for improvement lies with the client; consultations are merely a catalyst for change.
Important Insurance Notice: Rebecca Harder's services are not covered by health care services and are not reimbursed by insurance, Medicare or any other third-party payor. Payment in full (currently waived for internship nutrition hours) is required at each visit. Clients agree not to submit claims for these services, are responsible for payment even if an effort is made to obtain reimbursement that is denied, whether because services are “non-covered” or “not medically necessary.”
Cancellation Policy / Refund Policy Office Policies: At least a 24-hour cancellation is required to reschedule or cancel a health coaching session. If a client re-schedules or cancels with less than a full 24 hour notice, the session will count towards the package or service paid for regardless of any circumstance, change in work, travel, childcare, emergency or health situation. There are no refunds on services or products. I also understand and agree that there are no refunds on any service, product, digital good or health coaching from Rebecca Harder (Gastra Girl) and that if I am not happy with the Gastra Girl service or products suggested, that I will not ask for a refund or expect a refund. I understand it is my responsibility to research all suggestions Rebecca Harder makes and take full responsibility for doing them and hold Rebecca Harder (Gastra Girl) completely blameless.
Authorization I hereby authorize consultation or health coaching in wellness and lifestyle activities from Rebecca Harder (Gastra Girl Holistic Health Coach). I understand and agree to the financial and other terms set forth above. I understand the nature of this consultation, including the risks of possible adverse reactions. I have been adequately informed, and my questions have been satisfactorily answered. I am solely responsible for the decision to see Rebecca Harder (Gastra Girl Health Coach). I represent that I am seeking assessment and consultation to further my own health and for no other reason.
I do not represent a third party and sign this voluntarily.