Client Agreement Form - BRENNA BRAY, PHD

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BRENNA BRAY, PHD

Brenna Bray, PhD Health Coach
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Brenna Bray, PhD Health Coach
Services
Coaching Philosophy
About Dr. Bray
- Research
- In the Press
Blog
Client Forms
Client Resources

BRENNA BRAY, PHD

Brenna Bray, PhD Health Coach
Services
Coaching Philosophy
About Dr. Bray
- Research
- In the Press
Blog
Client Forms
Client Resources

Menu

Brenna Bray, PhD Health Coach
Services
Coaching Philosophy
About Dr. Bray
- Research
- In the Press
Blog
Client Forms
Client Resources

Client Agreement Form

Please complete the patient agreement form below and either submit or email the completed form to Dr. Bray (brenna@brennabray.com) at least 48 hours before your first scheduled appointment.

Welcome! During the coming six months, you will learn ways to help yourself achieve a healthier diet and lifestyle. Please read through the following program agreement form and if anything is unclear, please ask!

Please check this box to indicate your understanding and agreement.

The details of the service(s) you have purchased are outlined on the Services page of Dr. Bray's website (https://www.brennabray.com/book/) and in your purchase receipt. If you have any questions about the service(s) you have purchased, please ask.

Please check this box to indicate your understanding and agreement.

As specified on the booking page, all purchases are final and non-refundable. Bookings can be made on the booking page upon purchase. We ask that all bookings be made 3 days in advance of the scheduled appointment to allow Dr. Bray adequate time to prepare. Cancelation requests will be honored and re-scheduled so long as they are made more than 48 hours before the scheduled appointment. Please arrive to all scheduled appointments on time. Late arrivals result in shorter appointments. All scheduled appointments will end at the scheduled time. If additional time is needed, this can be scheduled through the bookings page of Dr. Bray's website.

Please check this box to indicate your understanding and agreement.

The role of the Health Coach is not to prescribe or assess micro- and/or macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor.

Please check this box to indicate your understanding and agreement.

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

Please check this box to indicate your understanding and agreement.

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

Please check this box to indicate your understanding and agreement.

The Client expressly assumes the risks of the Program, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has or will have in the future against the Coach, arising from the Client’s past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Coach.

Please check this box to indicate your understanding and agreement.

The Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled to by law.

Please check this box to indicate your understanding and agreement.

In the event that there ever arises a dispute between Coach and Client with respect to the services provided pursuant to this agreement or otherwise pertaining to the relationship between the parties, the parties agree to 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.

Please check this box to indicate your understanding and agreement.

This agreement shall be construed according to the laws of the State of Colorado. 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.

Please check this box to indicate your understanding and agreement.

If the terms of this Agreement are acceptable, please sign the acceptance 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 Coach and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.

Please check this box to indicate your understanding and agreement.

By providing your name and date below, you are indicating your understanding and agreement of all terms of the service(s) you have purchased.

Please check this box to indicate your understanding and agreement.

Client Name (First and Last). This serves as your electronic signature.

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