Statement of Acknowledgement and Informed consent
This form must be signed before our workshops/nutrition/fitness/coaching can commence.
The purpose of this DISCLAIMER AND NOTICE is to make you conscious of the potential risks connected with activity in any exercise, physical fitness or training program. And to help you make an informed decision about whether you should participate in these activities.
You should understand that participating in any exercise or exercise program carries the possibility of physical injury. You should be in good physical condition and able to participate in the exercise. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, and assume all risk of injury to yourself.
Life Coaching is a powerful yet safe professional relationship between a coach and a client. Where the client identifies his/her ambitions/passions and challenges. Life Coaching is not advice, therapy or counselling, it does not focus on origins and problems. It is about empowering people to realise their own inner potential and achieve positive outcomes. In order for coaching to have the maximum impact you will need to be open and honest about your challenges and needs, keep agreements, and stay committed to your goals. Coaching allows you to be the expert, be in control and set your own goals, holding you responsible and accountable for outcomes of your own actions. – I understand that life coaching is not a substitute for professional therapy or counselling, it focuses on practical application and provides skills and strategies that nurture personal development. – I understand this is a group ‘coaching and personal development programme’ where one-to-one coaching and group coaching will take place. – I understand in order for this support to be effective, I need to commit to all the sessions and my self-development. Holding myself responsible and accountable for the outcomes of my own actions.
By signing this statement of acknowledgment, you understand that:
- Healthy nutrition supports the body’s natural defense and resistance, however, no claim can be made about the efficacy of any naturopathic nutritional advice
- I am a Nutritional Therapist and NOT a conventional medical doctor (GP). Any treatment you receive is not mutually exclusive from any treatment or advice you may now be receiving or may receive in the future from any other licensed health care practitioner.
- I am not permitted to diagnose or claim to treat any medical conditions.
- Nutritional advice is not a substitute for professional medical advice and or Treatment from your GP.
The client understands and agrees to the following:
- You are responsible for contacting your GP about any health concerns.
- If you are receiving treatment from your GP or any other medical provider you should tell him/her about any nutritional strategy provided by myself as a Nutritional Therapist. This is necessary because of any possible reaction between medication and the nutritional programme.
- You must inform your Nutritional Therapist about any medical diagnosis, medication, herbal medicine, and supplements you are taking as this may affect the Nutritional programme. This must be recorded in your initial assessment.
- You must inform your Nutritional Therapist of any Known allergies and food intolerances.
- The treatment and/or referral to other health care practitioners is based on the assessment of your health, revealed through personal history, examination, laboratory testing, and any other appropriate method of evaluation.
- I reserve the right to determine which cases fall outside my scope of practice, in which event the appropriate referral will be recommended.
- Changes in dietary habits are not an absolute prerequisite for treatment and you understand that failure to follow sound nutritional, exercise and lifestyle programs could undermine any expected results.
- You are accepting or rejecting this care of your own free will.
- The ultimate responsibility for your health care is your own and that I am here to support you in this. I reserve the right to discontinue my services where it is apparent that your expectations and what I can provide are not in agreement.
- I also recognise that even the gentlest therapies, supplements and medications potentially have their complications in certain physiological conditions, in very young children, in those on multiple medications, in pregnancy, while breastfeeding and hence the information provided is complete and inclusive of all health concerns including risk of pregnancy; all medications, including over the counter drugs and supplements. The slight health risk of some Nutrition treatments includes, but not limited to; aggravation of pre-existing symptoms, allergic reaction to supplements or herbs; pain, fainting, bruising or injury from acupuncture.
We would always recommend you discuss any dietary or supplemental concerns or changes you wish to make with your GP. MEDICATION SHOULD NEVER BE DISCONTINUED OR DOSAGE AMENDED WITHOUT YOUR GP’S PRIOR KNOWLEDGE AND AGREEMENT.