Waiver and Release for Nutrition Counseling, Wendy Wesley Nutrition, LLC I acknowledge that I am aware that Wendy Wesley Nutrition, LLC (FKA Boil Water, Garden Nutrition, LLC) its members, officers, agents, employees and independent contractors are not medical doctors and do not diagnose disease. I also acknowledge that I have been warned that I should consult a Physician before undergoing any dietary or food supplement changes. I also affirmatively state that I have disclosed any and all known medical or genetic conditions, medications I use, and any significant personal or family medical history. Any recommendations that I follow for changes in diet, including but not limited to the use of food supplements, are entirely my choice and my responsibility. I am knowingly assuming any risk associated with nutritional counseling. In consideration of my participation in nutrition counseling, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release Wendy Wesley Nutrition, LLC (FKA Boil Water, Garden Nutrition, LLC), its members, officers, agents, employees and independent contractors from any liability whatsoever to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness, injury or other harm to my person, including my death, that may result from or occur during my participation in nutrition counseling, whether caused by the sole or concurrent negligence of Wendy Wesley Nutrition, LLC (FKA Boil Water, Garden Nutrition, LLC), its members, officers, agents, employees and independent contractors. I further agree to indemnify and hold harmless Wendy Wesley Nutrition, LLC (FKA Boil Water, Garden Nutrition, LLC), its members, officers, agents, employees and independent contractors, to the fullest extent permitted under law, from any and all liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described nutrition counseling session. No Refunds. Except as expressly provided herein, all payments under this Agreement will be irrevocable, non-refundable, and non-creditable. This agreement is made between Wendy Wesley Nutrition, LLC and Client. The State of Florida will govern all matters arising out of, or relating to, this Agreement. Services: You are hiring me to provide one-on-one, individualized nutritional counseling services to address the multi-layered facets of health and wellness. The details of the package you purchased are made a part of this Agreement. Nature, Length & Outcome of Sessions: Your first counseling session is a 60-minute Initial Consultation. During this session, we will discuss your health history, diet, and lifestyle factors as well as your nutrition and wellness goals. For this session to be effective, you should complete the Client Intake Form located on WendyWesleyNutrition.com. After the Initial Consultation, follow up sessions will be 30-45 minutes. At the end of each session, we will discuss a roadmap and action items. I am committed to making each session meaningful and productive. I ask you to take responsibility for creating value and results for yourself by completing Intake Forms, food logs, and other assessment material on a timely basis. Contact & Communication: Please feel free to contact me between scheduled follow-up sessions for simple questions and accountability check ins by email and text. I will respond to messages between 9:00 AM EST & 5:00 PM EST Monday thru Friday. I may respond outside of normal business hours, but it is not required. All clients and potential clients are added to my e-mail distribution list. We will never send you spam or sell your information. You can unsubscribe at any time. Insurance: Wendy Wesley Nutrition LLC accepts no insurance. Fees & Payment Policy: You agree to the designated fees detailed in your selected program at the time of Agreement. Payment must be made in advance of services unless other arrangements have been made. I accept cash, personal checks, Visa, MasterCard and Discover. A 3% convenience charge applies to credit card payments. There is a $25 fee for any returned checks. If you have pre-paid fees, or committed to a payment plan for follow-up appointments or on-going individualized programming, these fees cannot be refunded or exchanged at any time. If you have agreed to payment of a package through a monthly plan, you will be charged automatically each month for the duration of the package. Cancellations and Missed Appointments: If you need to move or cancel your scheduled appointment, please do so 24 hours in advance. There is a $50 cancellation for any appointment cancelled with less than 24 hours notice. You are responsible for the full session fee if you fail to show up for your appointment without any notice, regardless of the reason. Should I ever have to cancel within 24-hours of the appointment, your next follow up appointment will be free of charge. Timeline: Clients must use one-on-one sessions within the agreed upon program length of time. Sessions not used within that time will expire. Extenuating circumstances will be considered on a case by case basis and must be discussed and agreed upon. Confidentiality: As a part of nutritional counseling services, you may be asked to provide information concerning your physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. I will hold this information in confidence and will not release or disclose this information outside of the practice without your prior consent, except as required by applicable law. Your verbal or written approval may be requested to highlight you on social media platforms and you can opt out or in at your own discretion. Information you share about your progress in the program can be used anonymously on social media without verbal or written approval. Impossibility: Notwithstanding the above, either party may choose to be excused of any further performance obligations in the event of a disastrous occurrence outside the control of either party, such as, but not limited to: 1. A natural disaster (fires, explosions, earthquakes, hurricane, flooding, storms or infestation); or 2. War, Invasion, Act of Foreign Enemies, Embargo, or other Hostility (whether declared or not); or 3. Any hazardous situation created outside the control of either party such as a riot, disorder, nuclear leak or explosion, or act or threat of terrorism. Acceptance of Terms: The action of the sending and receipt of this agreement via an electronic method will hold both parties in acceptance of these terms. The Licensed Registered Dietitian, as sender and the client as the recipient, will acknowledge acceptance of these terms either by selecting the “I have read and agree to the terms above” box, an e-mail noting acceptance, or acceptance is acknowledged at the beginning of any work. Electronic acceptance shall be considered legal and binding. I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN NUTRITION COUNSELING AND OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. Revised 11/8/2022