6 Month Health Program

1. Consultation Program Agreement
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It is a pleasure to welcome you to this Program. During the coming six months, you can
expect major, positive changes to your health. Please read the following. If anything is
unclear, please ask.
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This agreement made today between the Holistic Nutritional Consultant/Detoxification
Specialist of the Program, and the Person named at the end of this document [the client].
The program you are about to enroll in will include all of the following:
1. Two 50-minute appointments each month, which will include discussion of client
progress, recommendations, a set of notes, with possible materials to take home. It
is also important to know that the environment provided will be a safe and
confidential one.
2. A customized herbal program which will aid in detoxification, rejuvenation, and
optimization of primary organ systems, (Lymphatic, Kidney/Bladder,
Liver/Gallbladder, Brain/Nervous System, Heart, Blood, Thyroid/Parathyroid,
Adrenals, and Endocrine System) as well as careful monitoring and necessary
modifications and adjustments to the program. *(This is optional, yet highly
recommended for full effectiveness of program)
3. A variety of handouts, recipes, video links, food samples, and other materials.
4. Weekly email support for questions and concerns that may arise between sessions.
5. Grocery and Health food store tours, on what to look for in quality products, how to
shop healthfully, how to pick ripe fruit/fresh greens, and other shopping tips.
6. Private home sessions for smoothie making and juicing.
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SCHEDULING
As your Holistic Nutritional Consultant/Detoxification Specialist, I honor that my clients
have busy schedules, and take pride on not keeping them waiting or longer than planned.
Each session will end 50 minutes after it was scheduled to begin. Please be on time. If the
Client needs to cancel or re-schedule the appointment, the Client must do so 24 hours in
advance, otherwise, the Client will have forfeited that appointment and will not have an
opportunity to reschedule it.
Your program begins _____________________________ and ends ______________________________.
The Program expires if all 12 sessions have not been completed within two months after the
end date specified above.
PAYMENTS AND REFUNDS
The Client understands that the cost of the program is $225 a month for six months. Upon
commencement of the program, the full amount is due and must be paid in full. However, in
order to assist the Client in affording the cost of the Program, the Client may pay for the
program in monthly installments, due on the first meeting of each month, and must be paid
in cash or check. If the Client selects to pay the full cost of the program today, the cost shall
be reduced by $150, for a total cost of $1200.
In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will
remain fully responsible for the pro rata share of the program that has been delivered.
The Holistic Nutritional Consultant/Detoxification Specialist reserves the right to cancel the
Program if at any point he or she feels it is not advantageous for the coaching program to

2. Consultation Program Agreement
continue. If this happens, the Client is only responsible for the pro rata share of coaching
services received.
DISCLAIMERS
The Client understands that the role of the Holistic Nutritional Consultant/Detoxification
Specialist is not to prescribe or assess the micro- and 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 Holistic
Nutritional Consultant/Detoxification Specialist is a mentor and guide who has been trained
in holistic health coaching to help clients reach their own health goals by helping the client
to devise and implement positive and sustainable lifestyle changes. The Client understands
that the Holistic Nutritional Consultant/Detoxification Specialist 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 Consultant/Specialist 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 supplement use with his or her doctor.
The Client has chosen to work with the Holistic Nutritional Consultant/Detoxification
Specialist 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 care
professionals.
PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS
The Client acknowledges that he or she 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, including the risks of trying new
foods, supplements, and herbs and the risks inherent in making lifestyle changes. The Client
releases the Holistic Nutritional Consultant/Detoxification Specialist 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 Holistic Nutritional
Consultant/Detoxification Specialist.
Under no circumstances will the Counselor refund any payments made by the Client. By
signing this agreement, the Client agrees to be legally obligated to pay the full amount of
this Program.
CONFIDENTIALITY
The Holistic Nutritional Consultant/Detoxification Specialist will keep the Client’s
information private, and will not share the Client’s information to any third party unless
compelled to by law.
ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES
In the event that there ever arises a dispute between Holistic Nutritional
Consultant/Detoxification Specialist 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

3. Consultation Program Agreement
Arbitration Association Rules). Any judgment on the award rendered by the arbitrator(s)
may ne 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 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.
This agreement shall be construed according to the laws of the State of Oregon. 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.
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 the contents with the Holistic Nutritional
Consultant/Detoxification Specialist and, if desired, to have it reviewed by an attorney; and
(3) the Client understands, accepts, and agrees to abide by the terms hereof.
Holistic Nutritional Consultant/Detoxification Specialist name: ________________________________
Signature: ___________________________________________________ Date: __________________________________
Client name: __________________________________________ Signature: ___________________________________
Date: ______________________________
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