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This Agreement is made today between Stephanie Solaris, and the client: Name* Date of Birth* Today's Date*
The Program in which you are about to enroll will include all of the following:
A. Ongoing sessions at $120 (or discounted when session packages are purchased) and continued support thereafter at the same rate. Sessions include discussion of your progress, recommendations, body composition assessments, nutrition, and supplement recommendations. There are absolutely no refunds on any services rendered in the form of the Initial consultations or sessions.
B. Your commitment to completing a daily food journal and bringing it to each session.
C. Program – Health, Nutrition, Supplementation, Recommendations and Consultations I have read the preceeding paragraphs and I fully understand the policy.*
SCHEDULING
I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Please be on time. If the Client needs to cancel or reschedule the appointment, the Client must do so 24 hours in advance, otherwise, the Client will forfeit that appointment and not have an opportunity to reschedule it. I have read the preceeding paragraph and I fully understand the policy.*
PAYMENTS & REFUNDS
The Client understands that the regular cost of the Program $120 per session and special offers thereafter for continued support. In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain fully responsible for the unpaid balance of the Program. Under no circumstance will the Counselor refund any payments made by the Client. By signing this Agreement, the Client agrees to be legally obligated to pay the full amount of this Program. I have read the preceeding paragraph and I fully understand the policy.*
DISCLAIMER OF HEALTH CARE RELATED SERVICES
The Counselor encourages the Client to continue to visit and to be treated by his/her healthcare professionals, including, without limitation, a physician. The Client understands that the Counselor is not acting in the capacity of a doctor, licensed dietician-nutritionist, massage therapist, psychologist or other licensed or registered professional. Accordingly, the client understands that the Counselor is not providing health care, medical or nutrition therapy services and will not diagnose, treat or cure in any manner whatsoever, any disease, condition or other physical or mental ailment of the human body. The Client has chosen to work with the Counselor and understands that the information received should not be seen as medical or nursing advice and is certainly not meant to take the place of your seeing licensed health professionals. I have read the preceeding paragraph and I fully understand the policy.*
PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS
The Client acknowledges that the Client takes full responsibility for the Client’s life and well-being, as well as the lives and well-being of the Client’s family and children (where applicable), and all decisions made during and after this program. The Client expressly assumes the risks of the Program, whether or not such risks were created or exacerbated by the Counselor. The Client releases the Counselor, his/her heirs, executors, administrators and assigns, its officers, directors, shareholders, employees, teachers, lecturers, agents, health counselors and staff (collectively, the Releasees) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, which against the Releasees, the Client ever had, now has, or will have in the future against the Releasees, arising from the Client’s past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Releasees. I have read the preceeding paragraph and I fully understand the policy.*
CHOICE OF LAW, ARBITRATION AND LIMITED REMEDIES
This agreement shall be construed according to the laws of the State of New Jersey. In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. In the event a dispute arises between the parties, either arising from this Agreement or otherwise pertaining to the relationship between the parties, the parties will submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules). Any judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the Client in the event that an award is granted in arbitration, is refund of the Program Fee. Without limiting the generality of the foregoing, no award of consequential or other damages, unless specifically set forth herein, may be granted to the Client. If the terms of this Agreement are acceptable, please sign the acceptance below. By doing so, the Client acknowledges that: (1)he/she has received a copy of this letter agreement; (2)he/she has had an opportunity to discuss the contents with the Counselor and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof. I have read the preceeding paragraph and I fully understand the policy.* Counselor name Counselor signature – please sign using your mouse or iPad stylus: Today's Date Client name Client signature – please sign using your mouse or iPad stylus:* Today's Date 