Mary Vance, NC offers the services of holistic nutrition: counseling on lifestyle and nutrition.
I, the undersigned, agree that I am a voluntary participant in lifestyle and nutrition counseling sessions and programs offered by Mary Vance, NC and that I accept and pay for those services. I reserve the right to refuse participation or to withdraw at any time.
I agree to provide at least 24 hours notice of any cancellation. Notice shall be given pursuant to email to
[email protected].
If I do not give 24 hours notice, I understand that I will pay for the session in full.
I understand the nutritional counseling services are designed to empower individuals to achieve their health goals and may include, but will not necessarily be limited to the following:
• providing a lifestyle intervention to establish healthy eating habits
• specific recommendations to support the body in improving specific health concerns
• recommendations around exercise, rest, stress reduction
• nutrition supplementation to support wellness
• menu planning and daily journaling suggestions
• work on self image and attitudes
Mary Vance, NC is not a physician nor psychologist, and the scope of her consultation services does not include treatment or diagnosis of specific illnesses or disorders. If you, the client, suspect you may have an ailment or illness that may require medical attention, then you are encouraged to consult with a licensed physician without delay. Only a licensed physician can prescribe drugs. Any mention of drugs in the course of consultation is only for the purpose of providing a complete history of drugs that the client is taking and not for Mary Vance, NC to judge the appropriateness of the medication. Any change in prescription or dosage is a decision the client makes with his or her physician.
The counseling/coaching offered under this Agreement is acknowledged and understood to be of a strictly non-medical nature. The services provided by Mary Vance, NC are at all times restricted to consultation on the subject of lifestyle and nutrition matters, intended for augmenting general health, and do not involve the diagnosing, prognosticating, treatment, or prescribing for treatment of disease.
By checking the box above, you acknowledge that you understand that Mary Vance, NC is a health and nutrition consultant and not a physician. Mary Vance, NC will not be held liable for failure to diagnose or treat an illness, nor will she be liable for failure to prevent future illness.