Informed Consent For Functional Nutrition Services

Welcome to ReConnect, an integrative health center Where Mind, Body & Soul Heal Together. This document contains important information about the Center’s professional functional nutrition advice services and business policies. “I”, “Us”, “We”, “Our”, “Ours” and other first-person pronouns will refer to the Center, as well as all employees, contractors, and/or affiliates of the Center. You, as the Client, may be referred to throughout this Agreement with second-person pronouns such as “You”, “Your”, “Yours.” This informed consent may be amended at any time by reasonable notice, including without limitation by posting revised content on the Center’s website at www.reconnecthealth.com, which amended terms shall be binding upon you.

Functional Nutrition and Lifestyle Consultation Process

This service is intended to educate you and enhance your knowledge of wellness as it relates to foods, dietary supplements, and behaviors associated with eating and wellness, as well as help you meet your nutritional goals. Functional nutrition services may complement the care of other healthcare providers, but are not a substitute for diagnosis, treatment, or care of any disease by a licensed medical professional. Functional nutrition services are in no way intended to be construed as medical advice or care. You should continue regular medical supervision and care by your primary care physician and/or other healthcare providers.

A certified nutrition professional will work with you to develop an appropriate nutrition and lifestyle program tailored to your individual needs and help monitor your progress in meeting these goals. It is your responsibility to decide which dietary and lifestyle changes to follow, having discussed any potential risks and benefits of these changes with your other healthcare providers and/or by facilitating a conversation between your healthcare provider(s) and our nutrition professional. Because each client is unique, no guarantees can be made about your specific progress when starting and following a nutrition wellness program, however every effort will be made to educate you on reasonable expectations. You acknowledge and understand that no warranties or representations have been made to you regarding the results you will achieve from this program. You understand that results are individual and may vary.

Functional Nutrition and Lifestyle Sessions

Normally all functional nutrition services begin with 1) a discovery meeting lasting approximately 45 minutes and 2) an intake session of approximately 45-60 minutes. Subsequent sessions are 30-60 minutes in length depending on need and are prepared for with supporting research and data to facilitate an effective meeting. The number and length of sessions may vary according to the nutrition wellness program that best meets your needs.

You may schedule your nutrition and lifestyle appointments on our website www.reconnecthealth.com or via phone, email, or text message. Fees vary according to the type of service recommended and will be agreed to when such service is requested. Fees are due at the time of service and may be paid via cash, Zelle, personal check, or credit card. If paying by credit card, for your convenience we will keep your credit card information on file with the Center and charge you every time we complete a session.

Multiple-session packages are also offered for this service which result in significant savings over single-session fees. Packages are billed in equal monthly installments and are not refundable if you are unable to complete all sessions in the time specified. We will discuss these optional packages during our initial consultation.

We have a fully booked Center with many patients on a waiting list, so please cancel or reschedule your appointments at least 24 hours in advance, or you will be charged the full fee for the missed appointment.

Online Functional Nutrition Advice Sessions

Online sessions are like regular in-person appointments, but we will work together online via Zoom, which is a HIPAA compliant video conferencing service, or over the phone. The same fee rate shall apply for online sessions as it does for in-person appointments.

Although there are benefits of remote sessions, there are some differences between in-person sessions, as well as some risks such as risks to confidentiality, issues related to technology, handling of emergencies, and overall efficacy. I would be happy to discuss this in more detail during our initial consultation. Online functional nutrition sessions will only be provided during the Center’s normal business hours.

Confidentiality

You have the absolute right to the confidentiality of your functional nutrition program. All personal information you share with the Center will be kept strictly confidential, unless you consent to sharing it or unless mandated by law.

Occasionally we may need to consult with other professionals in their areas of expertise to provide the best nutrition wellness program for you. Information about you may be shared in this context without using your name or any information that may identify you.

Finally, if you elect to communicate with the Center by email or cellular text message (SMS), please be aware that email and text messages are not secure, and confidentiality cannot be assured.

Termination of Functional Nutrition Advice/Complaints

A functional nutrition program involves a large commitment of time, money, and energy for both the Client and the Center. Normally you will decide when to pause or end your nutritional program work. However, the Center may unilaterally decide to terminate the ongoing program sessions if that is in the best interest of the Center and/or the Client. In such situations, if requested the Center may offer referrals to other sources of nutrition advice but cannot guarantee that they will be available.

If you ever feel that you are not satisfied with the functional nutrition services provided by the Center, please talk to us about it so that I can respond to your concerns. We will take such feedback seriously, and with care and respect.

You agree that any controversy or claim for damages arising out of or relating to my Center’s functional nutrition services shall be settled by arbitration administered by the American Arbitration Association in accordance with its Arbitration Rules, and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. You agree that any claims for damages will be limited to the total fees paid by you during the functional nutrition advice process. In any such proceeding, if we are the prevailing party, you agree to an award for attorney’s fees and costs for such sum that the Arbitrator deems appropriate.