April Whole30

Returning Client Group Coaching 

 

Please complete the form below

Name *
Name
Informed Consent *
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. Kelly Warner and Show-Me Whole Living 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 Kelly Warner and Show-Me Whole Living. I have discussed with Kelly Warner and Show-Me Whole Living the nature of the services to be provided. I understand that Kelly Warner 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 Kelly Warner and Show-Me Whole Living and agree to be personally responsible for the fees in connection with the services provided to me. By clicking below, you agree to the above terms and conditions for participation in Whole30 coaching with Kelly Warner and Show-Me Whole Living.
Health Notices *
Health Notices The Whole30 was developed by respected health professionals. However, Whole30 isn't a medical organization and we can't give you medical advice, treat you for any medical condition, or provide any specific recommendations relating to your medical condition. We strongly urge you to consult with your physician, primary health-care provider, and/or a Registered Dietitian before starting any dietary or lifestyle plan. We also urge you to get periodic medical checkups. The Whole30 can create physical changes that should be medically monitored. Medical monitoring is especially important for people with a known medical condition, pregnant or breastfeeding women, or those on prescription medication. The Whole30 is not advise for those with a history of disordered eating, unless administered under the care of a trained counselor. The Whole30 is healthful, but isn't intended to treat any illness or disease. In addition: I require written medical permission to participate in coaching services if you are a child under 17 years of age, pregnant, or with an active medical diagnosis of bulimia nervosa/anorexia/binge eating disorder/EDNOS. I prohibit participation in my coaching services for children under the age of 10. If you are being treated for an illness, taking prescription medication, or following a therapeutic diet to treat a disease, it's especially important to show the Whole30 plan to your physician or primary health care provider. Any modifications made to the plan by your provider(s) should be followed.