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Strength Axis Program Agreement
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It is a pleasure to welcome you as a participant in a Strength Axis Program to help you find healing opportunities to improve your health. During the upcoming weeks and months, you will learn ways to help yourself achieve a healthier lifestyle. It is common practice for naturopaths, nutritionists, and other non-licensed practitioners to collect your signature on a liability waiver form such as this. Please read the following, if anything is unclear, please ask.

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This Agreement is made between John Parker (Health Coach/Practitioner) and the Client. The Program Agreement in which you are about to agree to will/may include all of the following:
  1. Any lab results for kits administered
  2. Lab Results Worksheets, Report of Findings & Therapeutics Lifestyle Recommendations
  3. Supplementation Protocol and Supplement Schedule
  4. Phone and/or in-person consultation sessions to potentially include:
    1. 90 minute results review of lab results and report of findings
    2. 60 minutes questionnaires review and report of findings
    3. 30-60 minute review and training on supplementation protocol
    4. 30-45 minute follow up sessions to promote further progress with supplements and lifestyle changes
  5. Any follow up sessions for continued coaching
  6. Any group coaching sessions, webinars or workshops
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SCHEDULING

I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each coaching session will end within the time it was scheduled. Please be on time. If the Client needs to cancel or reschedule the appointment, the Client must do so 24 hours in advance; otherwise, the Client will forfeit that appointment and not have an opportunity to reschedule it.

The purchased consultation and/or session(s) expire if sessions have not been initiated within three months after the Purchase Date as indicated on the invoice. In addition, sessions will expire due to inactivity for 3 months once the program has been initiated. If your program is deemed inactive as prescribed and you wish to restart there will be an additional restart fee equal to 10% of your initial program fee.

CONSULTATION PAYMENTS AND REFUNDS

Upon commencement of the purchase of the consultation session(s), the full amount of the invoice is due and must be paid in full. However, in order to help the Client afford this Program, the Client may pay 2-3 payments via check or credit card.

In the event of the Clientís absence or withdrawal, for any reason whatsoever, the Client will remain fully responsible for the unpaid balance of the consultation(s). Under no circumstance will the Practitioner refund any payments made by the Client. With payment of the first consultation session this Agreement will commence, the Client agrees to be legally obligated to pay the full amount of all consultation sessions agreed upon. The client may "gift" the paid for sessions/program to another person of their choice if they wish. Any "gifting" of sessions must be made in writing with all parties in agreement and the gift receiver will be required to sign a program agreement acknowledging all other aspects of the terms of service.

If you make a mistake collecting saliva or urine specimens, etc., or if the lab refuses to accept specimens because of a mistake you made, a free replacement test kit will be provided to you. Please call the office before discarding any specimens collected. Otherwise, once test kits are in your possession, they may not be returned and no refunds are allowed for any test kits due to safety, hygiene and accuracy concerns.

DISCLAIMER OF HEALTH CARE RELATED SERVICES

The Practitioner encourages the Client to continue to visit and to be treated by his/her healthcare professionals, including, without limitation, a physician. The Client understands that the Practitioner is not acting in the capacity of a doctor, licensed dietitian-nutritionist, massage therapist, psychologist or other licensed or registered professional. Accordingly, the client understands that the Practitioner is not providing health care, medical or nutrition therapy services and will not diagnose, treat or cure in any manner whatsoever any disease, condition or other physical or mental ailment of the human body.

The Client has chosen to work with the Practitioner and understands that the information received should not be seen as medical or nursing advice and is certainly not meant to take the place of your seeing licensed health professionals.

It is your responsibility to deliver all laboratory test results, now and in the future, to your own physician for any medical interpretation or opinion regarding any laboratory results provided by The Practitioner or his/her affiliates. The undersigned agrees that he or she will receive a nutritional interpretation of the test results from The Practitioner that is to be used exclusively by the undersigned as an educational tool for personal health purposes. However, the personal physician of the undersigned may use these same laboratory results to diagnose and treat disease. The information on The Practitionerí web sites, brochures, flyers, and information packets are believed to be extremely accurate, but such accuracy cannot be guaranteed by The Practitioner, his/her independent representatives, associates and affiliates as we are not the originators of the underlying data used in the interpretation. The undersigned releases The Practitioner from any liability for injury or loss arising out of the use of, or reliance on, the laboratory results and/or the dietary, supplement and lifestyle suggestions provided. Before making any changes to the exercise, diet or nutritional or hormonal supplementation of the undersigned, a physician should be consulted.

The Practitioner does not diagnose, cure or treat any illness or disease. Out of reference laboratory reference range results will be indicated on the official lab result form provided by The Practitioner from a State Certified Laboratory to the undersigned. This information is not intended to, cannot, and should not be expected to substitute for a personal consultation with your own physician. Further, the undersigned releases The Practitioner, his/her lab partners, his/her independent representatives, associates and affiliates from any and all liability for any failure to identify any medical condition or disease. It is understood and agreed that this is not the purpose of their services.

Please initial here acknowledging that you have read this section and understand its contents.

PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS

The Client acknowledges that the Client takes full responsibility for the Clientís life and well-being, as well as the lives and well-being of the Clientís family and children (where applicable), and all decisions made during and after this program.

The Client expressly assumes the risks of the Program, whether or not such risks were created or exacerbated by the Practitioner. The Client releases the Practitioner, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders, employees, teachers, lecturers, agents, health Practitioners and staff (collectively, the Releasees) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releasees, the Client ever had, now has or will have in the future against the Releasees, arising from the Clientís past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Releasees.

CHOICE OF LAW, ARBITRATION AND LIMITED REMEDIES

This agreement shall be construed according to the laws of the State of California . In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. In the event a dispute arises between the parties, either arising from this Agreement or otherwise pertaining to the relationship between the parties, the parties will submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules). Any judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the Client in the event that an award is granted in arbitration is refund of the Program Fee. Without limiting the generality of the foregoing, no award of consequential or other damages, unless specifically set forth herein, may be granted to the Client.

If the terms of this Agreement are acceptable, please submit your signature below. By doing so, the Client acknowledges that: (1)he/she has received a copy of this letter agreement; (2)he/she has had an opportunity to discuss the contents with the Practitioner and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.

HIPAA CONFIDENTIALITY

Client acknowledges that during the course of performing contracted services for the Client, the Practitioner may send health information electronically via email or other sources that may not be secure. If the Client does not approve of this method of transfer they must notify the Practitioner and a secure form of transmitting information will be established.

Jenn Culver Malecha (Practitioner) acknowledges that during the course of performing contracted services for the Client, the Practitioner may have access to, use, or disclose confidential health information. Practitioner hereby agrees to handle such information in a confidential manner at all times while providing services for the Client and after the services are completed, and commits to the following obligations:

  1. Practitioner will use and disclose confidential health information only in connection with and for the purpose of performing services.
  2. Practitioner will request, obtain, or communicate confidential health information only as necessary to perform services and shall refrain from requesting, obtaining, or communicating more confidential health information than is necessary to accomplish services.
  3. Practitioner will take reasonable care to properly secure confidential health information on any computer and will take steps to ensure that others cannot view or access such information. When away from workstations or when tasks are completed, Practitioner will log off computers or use a password-protected screensaver in order to prevent access by unauthorized users.
  4. Practitioner will not disclose personal password(s) to anyone without the express written permission of the Client, or record, or post it in an accessible location and will refrain from performing any tasks using another's password.

Practitioner understands that as an independently contracted service provider, the use and disclosure of Client information is governed by the rules and regulations established under HIPAA, the Health Insurance Portability and Accountability Act of 1996, and related policies and procedures. Therefore, with regard to participant information, Practitioner commits to the following additional obligations:

  1. Practitioner will use and disclose confidential health information solely in accordance with the federal and company policies set forth above or elsewhere. Practitioner also agree to familiarize with any periodic updates or changes to such policies in a timely manner.
  2. Practitioner will immediately report any unauthorized use or disclosure of confidential health information that become aware of to the Client in writing.

Practitioner also understands and agrees that failure to fulfill any of the obligations set forth in this Agreement and/or violation of any terms of this Agreement shall result in being subject to appropriate lawful action, up to and including, termination of services.

By typing my full name in the box below I agree to all the terms and conditions within this document:

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