New Client Agreement - Lab Review

Assigned Health Coach: Amy Knaperek, PharmD, DipACLM

It is a pleasure to welcome you to PIVOT Integrative Consulting, LLC! Congratulations on your decision to start your journey to a lifestyle of health and wellness! During your time with PIVOT Integrative Consulting, LLC and your assigned Health and Wellness Coach, you will be exposed to multiple learning opportunities to achieve a healthier lifestyle and greater wellness. Please read and sign the following agreement so we can get started on your journey. If anything is unclear, please just ask for clarification. This agreement is made today between PIVOT Integrative Consulting and the Client named below.

The Lab Review offers the following:

A.      One LAB consultation appointment up to 60 minutes in a virtual platform. This will include review of an abbreviated health questionnaire, health history including prescription and prior labs obtained through another provider or review of recommended labs including, but not limited to: GI-MAP, ELISA Food Sensitivity, DUTCH, Nutrival, etc. The cost for these recommended labs is not included in the cost to review the results. All requested documents are to be submitted to the Health Coach at least 7 days prior to booked appointment.

B.      Clients are encouraged to provide honest feedback regarding the lab review and take detailed notes during the follow-up consultations. A documented summary of session recommendations will be sent via email after this session, including pertinent informational handouts as appropriate.

C.      Nominal email or text communication with questions and concerns, specifically to address follow-up support regarding topics covered during sessions is encouraged. However, additional support calls and follow-ups (beyond the lab review consultation provided) are not included and may incur an additional fee. Additional follow-up appointments may be requested by the client for an additional fee on an as needed basis.

DURATION AND SCHEDULING

The goal of PIVOT Integrative Consulting, LLC is to help the client become self-sufficient leaders of their own health and wellness goals. The Lab Review provides a snapshot into the clients health at the time the lab values were determined. The Client acknowledges that successful health and wellness programs have a minimum of 3-months of contact between the Coach and the Client and that this Lab Review is only to provide a brief evaluation based on the information presented at the time of service.

PIVOT Integrative Consulting, LLC understands that clients have different needs and schedules. The Health and Wellness coach will work with the Client to determine an appropriate meeting time for all consultations and calls. We value your time and promise to be available during the scheduled meeting times. Please grant the Health and Wellness Coach the same respect and be on-time for the virtual sessions. The coach will allow for extra time during each session, however any time over 15 minutes longer than the scheduled time during the session may incur an additional payment at a rate of $2/minute.

If the Client needs to cancel or reschedule the agreed upon appointment time, the Client must do so in writing at least 48 hours in advance; otherwise, the Client will forfeit that session and owe payment for it up to 100% of the value. The Health and Wellness Coach will also provide the Client at least a 48-hour notice of the need to reschedule due to unexpected events or emergencies. If the Health and Wellness Coach is not able to provide 48 hours of advanced notice of cancellation or rescheduling, a 25% refund will be offered.

PAYMENTS AND REFUNDS

The Client understands the cost of this Program is $79 and is due in full at least 5 days in advance of the consultation appointment. The Client will pay for the service by bank account withdrawal, Health Savings account, or credit card through the online payment portal. In the event of the Client’s absence or withdrawal, for any reason, the Client will remain fully responsible for the full price of the program due to the upfront investment in developing a specific review for the Client. Special circumstances will be considered on a case-by-case basis. Additional services beyond what is included in The Program will be charged as follows for each incidence: Additional Laboratory Review $79: Medication Therapy Management Review $99; Follow-up Consultation $99 (up to 60 minutes); Additional Check-In Call $49 (30 minutes+); Additional Quick Call $29 (less than 30 minutes).

DISCLAIMER OF HEALTH CARE RELATED SERVICES

The Health and Wellness Coach encourages the Client to continue to visit and be treated by his/her healthcare professionals, including, but not limited to a physician, dietician, physical or occupational therapist, etc. The Client understands that the Health and Wellness Coach is not acting in the capacity of a doctor, licensed dietitian-nutritionist, therapist, psychologist or other licensed or registered professional. Accordingly, the Client understands that the Health and Wellness Coach does not provide health care, medical or nutrition therapy services and will not diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. The Client has chosen to work with the Health and Wellness Coach and understands that the information received should not be seen as medical or nursing advise and is not meant to take the place of treatment by licensed health professionals.

PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS

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. The Client expressly assumes the risks of the program, whether or not such risks were created or exacerbated by the Health and Wellness Coach. The Client releases the Health and Wellness Coach, his/her heirs, executors, administration and assigns its  officers, directors, shareholders, employees, teachers, lecturers, agents, health counselors 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 Clients past or future participation in, or otherwise with respect to, the Program.

CHOICE OF LAW, ARBITRATION, AND LIMITED REMEDIES

This agreement shall be construed according to the laws of the State of North Carolina and/or Georgia. If 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 American 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 if an award is granted in arbitration is refund of the entire 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 sign the acceptance below. By doing so, the Client acknowledges that he/she understands, accepts, and agrees to abide by the terms hereof. You will receive a copy of this letter agreement via email. 

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