Health Coaching Informed Consent and Waiver

I consent to participate voluntarily in a Wellness Coaching Program.  I hereby accept and assume any and all risk and liability associated with any treatment and/or products provided by Lakeside Natural Health LLC, and its agents, owners and/or employees.  

I hereby consent to the performance of an evaluation on me (or on the person named below for whom I am legally responsible), which may include but is not limited to computer assisted reiki healing and the receipt of information regarding herbs, supplements, diet & lifestyle for the purpose of enhancing my health.

I understand that reiki, herbal and diet therapy are not intended as a diagnosis, prescription or treatment for any disease, physical or mental, and is not a substitution for medical care.  I further understand that the agents, owners and/or employees of Lakeside Natural Health LLC are not licensed to practice medicine or provide any medical treatment or advice, and are not providing health care, medical or nutrition therapy services or attempting to diagnose, treat or cure in any manner whatsoever, any disease, condition or other physical or mental ailment of the human body.  I understand that the agents, owners and/or employees of Lakeside Natural Health LLC are not medical doctors and are only serving through a role of Wellness Coach.

 I agree to seek the advice of my physician or another qualified health care professional prior to and during the Program regarding any questions or concerns I have about my specific health situation, possible or actual pregnancy, known or suspected food sensitivities or allergies, dietary restrictions, or any medications I am currently taking.  I agree to not disregard professional medical advice or delay seeking professional advice or stop taking any medications without speaking to my physician or health care professional.  

I agree to disclose to my Wellness Coach in advance any known or suspected food allergies or sensitivities, any physical limitations that may impact my breathing or movement, or any other health or mental condition that may affect or be affected during the Program.  If I suspect that I have a medical problem, I agree to inform Wellness Coach immediately.  

I understand that no claim is made as to the certain efficacy of any nutritional or supplement protocols. Additionally, I understand that this program may also include suggestions in regards to bringing balance to the physical, emotional, mental and spiritual components of my being.  These suggestions may include but are not limited to: food modifications, sleep patterns, stress reduction techniques, stretching and strengthening exercises, dietary supplementation, social interaction, and development of hobbies and career goals.  I understand that adopting any of these recommendations is voluntary and by choice.  

 I fully understand that all lifestyle recommendations, including but not limited to physical exercise and food are designed with my health, well-being and utmost safety in mind.  I have been informed and understand physical exercise and food modifications have been associated with certain risks, including but not limited to, musculoskeletal injury,  abnormal blood pressure responses, respiratory distress, and in rare instances heart attack or death.  I assume responsibility for my body and it’s composition.

I understand that recommended herbs are to be consumed or applied as directed, and that I am to immediately stop using them and to notify herbalist of any unanticipated or unpleasant effects associated with the use of herbs.  I understand and do not expect the Wellness Coach to be able to anticipate and explain all possible risks and complications of the recommendations.  I understand that some herbs may be inappropriate during pregnancy. I will notify the Wellness Coach if I am or become pregnant.  I understand that some herbs may affect medications. I will notify Wellness Coach if I start a new mediation.  I understand the results are not guaranteed.

I understand that all my records will be kept secure and confidential in accordance with federal and state guidelines, and that my records and other information will not be disclosed or released without my written consent.

I hereby assume any and all risk of injury to myself and others in my care. I further release, waive and discharge the Wellness Coach and Lakeside Natural Health LLC from any and all liability from any loss or damage, even injury resulting in death, whether caused by error or otherwise.  I will indemnify and hold harmless the Wellness Coach and Lakeside Natural Health LLC from any loss, liability, damage, expense or cost, whether caused by error or otherwise, and whether claimed by or through the undersigned or others, including costs and attorney’s fees incurred or suffered by reason of any claims, demands, actions or suits which may be filed or claimed against the Wellness Coach and Lakeside Natural Health LLC.  I agree to not sue the attending Wellness Coach or Lakeside Natural Health LLC and will not individually, or for others, or on behalf of minors, bring or prosecute, or in any way aid in the institution or prosecution of any claim or suit against the attending Wellness Coach and/or Lakeside Natural Health LLC.  References to the undersigned shall also include and obligate the undersigned’s spouse, family, children, guests, invitees, heirs, assigns and agents, and all persons claiming by or through the undersigned.  References to Wellness Coach and/or Lakeside Natural Health LLC shall benefit its owners, lessors, officers, employees, agents, successors and assigns.