Welcome & Thank You!
Words cannot begin to express how thankful I am that you chose me to help you with taking an empowered approach to your nutrition! I am so excited to get started! Before we begin all of the fun things, it is important that we have a clear understanding of how we’ll work together. For that reason, I have created this Client Coaching Agreement. This represents our solid commitment to complete our work together.
If you have any questions at any time please e-mail me at callie@callieexas.com.
Client Coaching Agreement
This agreement is made between Licensed Registered Dietitian, Callie Exas, and Client.
The State of New York will govern all matters arising out of, or relating to, this Agreement.
Services: You are hiring me to provide one-on-one, individualized nutritional coaching 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 coaching session is a 60 minute in depth evaluation. 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 must complete the following documents a minimum of 24 hours prior to this session:
New Client Questionnaire
After this initial deep dive, follow up coaching sessions will be 30-45 minutes. At the end of each session, we will discuss a roadmap and action items. For this session to be effective, you must complete the following document a minimum of 24 hours prior to these sessions so I know where you stand on those items, how I can be of service on our next call, and what victories I can celebrate with you:
Progress Check-In Form
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 questionnaires, food logs, and other assessment material on a timely basis. I am the coach and it is up to you to put forth effort and apply what you have learned.
Contact & Communication: Please feel free to contact me between scheduled follow-up sessions for simple questions and accountability check ins. I can be reached by email at callie@callieexas.com or via slack and 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: Callie Exas Nutrition & Wellness is proud to work in-network with multiple insurance companies. We will always do our best to ensure your sessions are covered by insurance. If for any reason, sessions are not covered by insurance, you the client are responsible for any fees or costs for service.
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.
I understand that not everyone is ready to commit to a lifestyle change, but for the consideration of others, please do not wait until the last minute if canceling your appointment. Please understand that my time is very much in demand; I set aside a time especially for you and do not overbook or take on more clients than my schedule permits. I am committed to providing the best services and nutrition care to all of my clients. When pre-paying for a package that commitment is shared by both of us. Please plan accordingly.
Timeline: My programs are designed for success based on expert experience. Clients must use one-on-one sessions within 6 months unless otherwise agreed upon. 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. If I receive no response from you for 1 month (30 days) from our last communication you will forfeit your payment and spot. I understand life happens, please let me know if something has come about and we need to push the coaching back.
Confidentiality: As a part of nutritional coaching 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 of Callie Exas Nutrition & Wellness 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.
HIPAA Notice of Privacy Practices: A full explanation of how medical information about you may be used and disclosed by Callie Exas Nutrition & Wellness and how you can get access to this information is described in the HIPAA Notice of Privacy Practices. You must read the HIPAA Notice of Privacy Practices prior to your first session . In signing this Coaching Agreement, you acknowledge that you have received and agree to terms outlined in the HIPAA Notice of Privacy Practices.
Assumption of Risk and Release of Liability: You must read the Assumption of Risk and Release of Liability prior to your first session. By signing this Coaching Agreement, you acknowledge that you have carefully read the Assumption of Risk and Release of Liability and agree to the terms outlined. You understand the Assumption of Risk and Release of Liability to be a full and final release of all costs, claims, causes of action and damages of any kind arising from or in connection with the nutrition counseling services.
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.