Schedule Appointment with Expedition Wellness

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Item	Quantity	Total
EW Beginner Membership Gift Certificate		$275.00
Total: $275.00	Coupon:

EXPEDITION WELLNESS • NEW CLIENT CONTRACT

Client Service Agreement

PURPOSE
The purpose of this Agreement is to help Client in reaching Client’s health goals, by helping Client devise and implement positive, sustainable lifestyle changes concerning dietetics and nutrition. To that end, the parties understand and agree to the following terms and conditions.

SERVICES
Dietitian will offer dietetic and nutrition information, consultation, and counseling to Client based on health and lifestyle information Client supplies as well as Dietitian's assessments (“the Services”).

I am independent and self-employed which means I will be working for you, not your care provider or hospital.
I will provide science-based weight loss information and consultation.
I will provide information and resources to enable you to make informed choices.
I will provide in-person coaching during our sessions as well as email support as needed.
I will draw on my knowledge and experience to provide emotional support, science-based weight loss strategies, accountability partnership and meal planning to help you reach your goals.
I will maintain the confidentiality of the details relating to your weight loss goals and progress unless I have first obtained your consent, giving me permission to share details.

PRODUCTS
Dietitians may recommend and/or offer for sale certain products and/or dietary supplements after performing a complete assessment of the Client's diet and based on the Client's unique nutrition needs. In the event that Dietitian have a financial relationship regarding the sale of recommended products and/or dietary supplements, this will be disclosed to the Client. Dietitian will also provide appropriate educational materials and inform clients on the availability of recommended products and equivalent products on the market.

SCHEDULING
Client has the ability to book sessions well in advance. As a courtesy, Client will make best efforts to be on time. Client’s allotted time starts running at the time it was scheduled. Cancellations and rescheduling must be done at least 24 hours in advance. Once an appointment is scheduled, Client will be expected to pay for it unless Client provides a 24-hour advance notice of cancellation.

CLIENT OBLIGATIONS

You agree to read and be familiar with the information that I provide for you.
You are in charge of your own grocery shopping and meal preparation.
You are responsible for logging your daily calorie intake in My Fitness Pal.
You are responsible for attending your coaching sessions as scheduled and being an active participant during the sessions.

AS A DIETITIAN

I do not perform clinical tasks, such as taking blood pressure, heart checks, medical exams, etc. I will use the Body Composition Analysis machine, along with measurements, to determine initial weight and program progress.
I do not make decisions for you. I will help you get the information necessary to make an informed decision. I will also remind you if there is a departure from your nutrition plan.
I will not prescribe, diagnose or treat any medical problems that may arise and will not be liable for interpreting diagnostic procedures. This is the role of your care provider.

PAYMENT
You agree to pay in full regardless of the outcome of your weight loss coaching and I agree to support you regardless of the outcome of your weight loss coaching.

Fees are to be paid in full, before coaching services will begin.

CANCELLATION POLICY
Clients may cancel their Membership at any time by contacting their dietitian/coach or cancel via payment confirmation email from Acuity prior to the next recurring charge. All fees are non-refundable. You agree to take full responsibility for cancelling your own recurring membership. In the event that Dietitian cancels this agreement, Dietitian will provide a prorated refund of the coaching fees based on the amount of sessions remaining.

NO GUARANTEES
Dietitian cannot guarantee the outcome of any weight loss coaching services and Dietitian's comments about the outcome are expressions of opinion only. Client acknowledges that Dietitian cannot guarantee any results for weight loss coaching services, as such outcomes are based on subjective factors that cannot be controlled by Dietitian.

CONFIDENTIALITY
Client information: Any and all client information and data of a confidential nature, including but not limited to, health history, current health issues, personal confidences (such as information regarding children or marriage) and weight loss progress or goals, shall be treated by Dietitian in the strictest confidence and not disclosed to third parties unless compelled to by law.

MEDIA CONSENT
Expedition Wellness, LLC takes pride in its services and clients. Through our participation in social media outlets such as Facebook and Instagram and/or the other outlets identified below, we share promotions, updates and other fun and helpful information that may benefit our clients. We do not share anything about specific clients without permission. If you choose to participate and want to authorize certain uses and disclosure, please fill out the form below.

I, hereby authorize Expedition Wellness, LLC and its affiliates and agents as follows:

To obtain and disclose the following types of information:

Photographic images of me
Video or audio of me and/or my voice
Information about date(s), time(s), and type(s) of services received
Information about my experience and/or results

For release and/or use in the following mediums and purposes:

News media (online, print and/or broadcast)
Website and social media
Advertisements
Medical and/or educational training
Closed circuit television programs
Publications and/or promotional materials
Any other lawful purpose

I understand that once my information is disclosed, it may be re-disclosed for Expedition Wellness, LLC-approved uses by third parties. I further understand that this authorization is entirely voluntary in my sole discretion and without compensation. I understand that my decision whether or not to execute this authorization has no effect on provision of services or insurance/payment. I understand that by signing this form I represent and warrant that I have sole authority to do so and that I have read and consent to the same. This authorization shall remain in effect unless/until I notify Expedition Wellness, LLC in writing that I revoke it for all future uses/purposes/disclosures.

DISCLAIMER
Expedition Wellness, LLC is owned and operated by Jessica Schroeder, RD (“Dietitian”). Dietitian is a registered and licensed dietitian. The Services provided pursuant to this Agreement are based on scientific evidence and credible medical research. Dietitian does not dispense medical advice nor prescribe medical treatment. The Services provided are designed to enhance the Client’s knowledge of health as it relates to food and dietary supplements, as well as behaviors associated with eating, fitness, and wellness. While such Services can be an important complement to the Client’s medical care, the Client understands that these Services are not a substitute for the diagnosis, treatment, or care of disease by the Client’s “Medical Care Team,” defined as physician, registered nurse, and other credentialed/qualified medical practitioners and/or professional health care providers. Working with a registered and licensed dietitian nutritionist should not and does not take the place of medical advice or care. Client should always discuss any fitness regime, dietary changes, or potential dietary supplements use, with his or her physician and/or other appropriate members of the Medical Care Team. If Client is under medical care or currently uses prescription medicines, Client should not cease conventional treatment or medication for any reason without consulting a physician. Client should seek advice from the appropriate member of his/her Medical Care Team if Client suffers from any conditions requiring medical attention and/or has any symptoms that concern Client.

PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS
Client acknowledges that Client takes full responsibility for Client’s life and well-being, and all decisions made during and after provision of the Services under this Agreement. Client expressly assumes the risks of the Services provided pursuant to this Agreement, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. Client releases Dietitian from any and all claims, demands, damages, sums of money, costs, expenses, actions, rights, causes of action, agreements, promises, obligations or liabilities of any kind whatsoever, whether known or unknown, fixed or contingent, suspected or unsuspected, existing in this or any other jurisdiction, which are held now, at any time in the past or at any time in the future that are in connection with, arise from, relate to or are on account of Client’s participation in, or otherwise with respect to, the Services provided pursuant to this Agreement, to the fullest extent allowed by law.

MISCELLANEOUS
This Agreement constitutes the complete and entire statement of all terms, conditions, and representations between the Parties with respect to its subject matter. Except as otherwise provided above, any waiver, amendment or other modification of this Agreement will not be effective unless in writing and signed by the party against whom enforcement is sought. This Agreement shall be governed by, interpreted and construed in accordance with the laws of the State of Iowa without regard to choice of law principles. The parties submit to the jurisdiction of the courts of the State of Iowa and agree that venue shall be in Polk County, Iowa. The parties hereby waive their right to any jury trial in any action, proceeding, or counterclaim brought by either party against the other. If any provision of this Agreement or its application is held to be invalid, illegal, or unenforceable in any respect, the validity, legality, or enforceability of any of the other provisions and application therein shall not in any way be affected or impaired.

If the terms of this Agreement are acceptable, please so indicate with your signature below. By doing so, Client acknowledges that:

(he/she has received a copy of this Agreement;
he/she has had an opportunity to discuss the contents with Dietitian, and if desired, to have it reviewed by an attorney; and
Client understands, accepts, and agrees to abide by the terms hereof.

I, the undersigned client, hereby warrant that I am competent to contract in my own name. I confirm that I have read the herein agreement prior to its execution and I am fully familiar with the contents thereof.