One on One Health Coaching Disclaimer and Health History

Congratulations on deciding to make some healthy changes and I am excited to start working with you.

To get started I need you to read and understand the disclaimer below and fill out the health history so I don’t waste your time with all these questions during our session.

Consent Form

Disclaimers: I understand that Amanda Patrick is a Certified Health Coach and does not dispense medical advice nor prescribe treatment or dietary needs. Rather, she provides resources to enhance my knowledge of health as it relates to foods, supplements, and behaviors associated with eating. I understand that health coaching is not a substitute for the diagnosis, treatment, or care of disease by a medical provider.

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 acknowledges that the support that they receive during their health coaching sessions is separate from the care that they receive from any medical facility in that the health coaching sessions are in no way intended to be construed as medical advice or care. The Client should continue regular medical supervision and care by their primary care physician.

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 the duration of the client’s wellness sessions.

The Client expressly assumes the risks of the health coaching sessions, including the risks of trying new foods, and the risks inherent in making lifestyle changes.

The Client releases Amanda Patrick Bliss Health Coaching 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 health coaching sessions, unless arising from the gross negligence of Bliss Health Coaching.

The Health 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 or with the consent of the Client.



Payment Information:
Payments are due before the time of service and there are no refunds for payments made to Bliss Health Coaching.

In the event that the client does not show up to an appointment or cancels within 24 hours of a scheduled appointment Bliss Health Coaching, reserves the right to charge the client 50% of the session payment fee. The above clause may be disregarded in the event of an emergency.

By filling out the health history and submitting it, you are agreeing to the consent form above that you have read and understand all aspects.


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