Holistic Movement with Debra Korn
Program Agreements
Please call (631) 255-5003 if you have questions about anything.
During the upcoming six months, you will learn ways to help yourself achieve a healthier diet and lifestyle.
Please read the following and electronically sign using the form below each agreement. If anything is unclear, just ask.
Debra L. Korn
Doctor of Naturopathic Medicine
Autoimmune & Alternative Oncology
Owner of Holistic Movement
Signature Program PIF
The Holistic Movement signature program PIF is a 6 month program for $600, paid in full, which includes:
A custom diet and food list
Monthly 45 minute check-in appointments
This Agreement is made today between the Coach of the Program and the person named at the end of this document, [the Client].
The Program in which you are about to enroll in will include all of the following:
1. Two 45 minute. Appointments monthly for 6 months, which includes discussions of your progress, recommendations & notes.
2. A variety of handouts, recipes, books, food samples, and other materials.
3. One custom Menu plan
SCHEDULING
As your Coach, I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each session will end 50 minutes after it was scheduled to begin. 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 will not have an opportunity to reschedule it.
This program expires if all 12 sessions have not been completed within two months after the End Date specified above.
PAYMENTS AND REFUNDS
The Client understands that the regular cost of the Program is $100.00 per month for six months. monthly payments are due on the first of each month, and may be made by credit card, Venmo or PayPal, an invoice will be sent. If the Client selects to pay the full cost of the program today, the cost shall be reduced by another $100 (for a total cost of $500).
In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain responsible for the pro rata share of the program that has been delivered, plus a cancelation fee of $50.
The Coach reserves the right to cancel the program if at any point she or he feels it is not advantageous for the coaching program to continue. If this happens, the Client is only responsible for the pro rata share of coaching services received.
DISCLAIMERS
The Client understands that the role of the Health Coach is not to prescribe or assess micro- and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor.
The Client has chosen to work with the Coach and understands that the information received should not be seen as medical or nursing advice and is not meant to take the place of seeing licensed health professionals.
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, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has or will have in the future against the Coach, 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 Coach.
CONFIDENTIALITY
The Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled to by law.
ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES
In the event that there ever arises a dispute between Coach and Client with respect to the services provided pursuant to this agreement or otherwise pertaining to the relationship between the parties, the parties agree to 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.
This agreement shall be construed according to the laws of the State of [your state]. 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.
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 Coach and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.
Signature Plus Program PIF
The Holistic Movement signature plus program is a 6 month program which includes everything in the Signature Program +
6 months of custom menu plans with food lists
Recipes
Bimonthly check-ins, 45 minutes each
$200 monthly for 6 months, or $900 ($150 monthly)
This Agreement is made today between the Coach of the Program and the person named at the end of this document, [the Client].
The Program in which you are about to enroll in will include all of the following:
1. Two 45 minute. Appointments monthly for 6 months, which includes discussions of your progress, recommendations & notes.
2. A variety of handouts, recipes, books, food samples, and other materials.
3. One custom Menu plan
SCHEDULING
As your Coach, I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each session will end 50 minutes after it was scheduled to begin. 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 will not have an opportunity to reschedule it.
This program expires if all 12 sessions have not been completed within two months after the End Date specified above.
PAYMENTS AND REFUNDS
The Client understands that the regular cost of the Program is $100.00 per month for six months. monthly payments are due on the first of each month, and may be made by credit card, Venmo or PayPal, an invoice will be sent. If the Client selects to pay the full cost of the program today, the cost shall be reduced by another $100 (for a total cost of $500).
In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain responsible for the pro rata share of the program that has been delivered, plus a cancelation fee of $50.
The Coach reserves the right to cancel the program if at any point she or he feels it is not advantageous for the coaching program to continue. If this happens, the Client is only responsible for the pro rata share of coaching services received.
DISCLAIMERS
The Client understands that the role of the Health Coach is not to prescribe or assess micro- and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor.
The Client has chosen to work with the Coach and understands that the information received should not be seen as medical or nursing advice and is not meant to take the place of seeing licensed health professionals.
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, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has or will have in the future against the Coach, 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 Coach.
CONFIDENTIALITY
The Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled to by law.
ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES
In the event that there ever arises a dispute between Coach and Client with respect to the services provided pursuant to this agreement or otherwise pertaining to the relationship between the parties, the parties agree to 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.
This agreement shall be construed according to the laws of the State of [your state]. 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.
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 Coach and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.
Signature Platinum Program PIF
The Holistic Movement platinum program is a 6 month program which includes everything in the Plus Program +
6 months of custom menu plans with food lists
Recipes
Bimonthly check-ins, 45 minutes each
2 one-on-one fitness classes for stretching, and 2 for resistance training. (I will also be sending you videos of each training course)
Pantry clean out
Grocery store tour
2 cooking classes
$300 monthly for 6 months, or $1500 PIF
This Agreement is made today between the Coach of the Program and the person named at the end of this document, [the Client].
The Program in which you are about to enroll in will include all of the following:
1. Two 45 minute. Appointments monthly for 6 months, which includes discussions of your progress, recommendations & notes.
2. A variety of handouts, recipes, books, food samples, and other materials.
3. One custom Menu plan
SCHEDULING
As your Coach, I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each session will end 50 minutes after it was scheduled to begin. 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 will not have an opportunity to reschedule it.
This program expires if all 12 sessions have not been completed within two months after the End Date specified above.
PAYMENTS AND REFUNDS
The Client understands that the regular cost of the Program is $100.00 per month for six months. monthly payments are due on the first of each month, and may be made by credit card, Venmo or PayPal, an invoice will be sent. If the Client selects to pay the full cost of the program today, the cost shall be reduced by another $100 (for a total cost of $500).
In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain responsible for the pro rata share of the program that has been delivered, plus a cancelation fee of $50.
The Coach reserves the right to cancel the program if at any point she or he feels it is not advantageous for the coaching program to continue. If this happens, the Client is only responsible for the pro rata share of coaching services received.
DISCLAIMERS
The Client understands that the role of the Health Coach is not to prescribe or assess micro- and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor.
The Client has chosen to work with the Coach and understands that the information received should not be seen as medical or nursing advice and is not meant to take the place of seeing licensed health professionals.
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, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has or will have in the future against the Coach, 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 Coach.
CONFIDENTIALITY
The Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled to by law.
ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES
In the event that there ever arises a dispute between Coach and Client with respect to the services provided pursuant to this agreement or otherwise pertaining to the relationship between the parties, the parties agree to 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.
This agreement shall be construed according to the laws of the State of [your state]. 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.
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 Coach and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.