Informed Consent

Consent form *
My Whole30 coaching services are intended to promote general health and wellness and are not intended to replace physician care or medical intervention. All nutritional assessments, suggestions and/or consultations on nutrition, diet and lifestyle are based on your input, and are not intended to diagnose, treat or cure any disease or ailment. You acknowledge and agree to accept all responsibility for reviewing diet, nutrition, and lifestyle suggestions with a licensed medical professional before following said suggestions. As with any program, there may exist inherent risks which may be relative to your state of health, fitness, awareness, care, and skill to which you conduct yourself. You agree that it is your responsibility to inquire about any recommendations with which you are not familiar, and provide any information which may limit your participation in the Whole30 program. Results and changes in your general health and wellness may vary depending on medical conditions, medications, and accuracy in following suggested guidelines. As your general health and wellness may change with modifications in diet, nutrition, and lifestyle, physician-prescribed medications may require modification. It is your responsibility to discuss this with your physician. Never reduce or eliminate physician prescribed medications without the direction of your physician or medical care provider. Your personal and health information will remain confidential and will not be shared without your consent. Whole30 Coach Jacob reserves the right to refuse services to any individual. Acknowledgement & Consent to Receive Services: I have read and understand the above disclosure about the Whole30 coaching services offered by Jacob Heath of Whole30 Coach Jacob. I have discussed with Jacob Heath the nature of the services to be provided. I understand that Jacob Heath of Whole30 Coach Jacob is not a licensed physician and that Whole30 coaching services are not licensed by the state, medically authorized, nor sponsored by any licensing bodies. I understand it is my responsibility to maintain a relationship for myself/my child with a medical doctor or licensed health provider. I have consented to use the services offered by Jacob Heath, and agree to be personally responsible for the fees in connection with the services provided to me. By signing below, you agree to the above terms and conditions for participation in Whole30 coaching with Jacob Heath.
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Name
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