The Pain Brain LLC Health Coaching Services & Course Informed Consent and Waiver

Welcome to health coaching for neuroplastic symptoms at The Pain Brain LLC. This informed consent and waiver document contains important information about our health coaching services and related business policies. Please read it carefully and let us know if you have any questions. We want you to have the best possible understanding of our services. 

Health Coaching Services

Health coaching is a general term for the process of facilitating healthy and sustainable behavior change and transforming individual goals into action. Health coaching can have benefits and risks. Health coaching is not a substitute for medical attention, examination, diagnosis, or treatment. Our health coaching will include exploration of your life experiences and general health with an overall focus on healing chronic neuroplastic symptoms by restoring healthy mind-body connections.

1. The Pain Brain LLC is not acting in the capacity of a medical doctor, licensed therapist or personal trainer, and that any advice given by The Pain Brain LLC is not meant to take the place of advice by these professionals. If you are engaging in our services, you should maintain a relationship with a healthcare professional who is responsible for your preventive health and chronic medical problems including current prescription medications. You should discuss any lifestyle changes with your health care professional, and should not discontinue any prescription medications without first consulting your health care professional.

2. The Pain Brain LLC is not to prescribe medications, provide healthcare, medical or nutrition therapy services, or to diagnose, treat or cure any disease, condition, or other physical or mental ailment of the human body, except those which are neuroplastic in nature.

3. The Pain Brain LLC is a mentor and guide who specializes in a holistic approach to neuroplastic symptoms therapy and mind-body health coaching to help clients reach their own health goals by facilitating a client’s examination of life experiences and lifestyle choices and to better understand their bodies and to implement a positive, sustainable and mindful approach to resolve neuroplastic symptoms and promote long-term wellness.

4. Client understands that in order to enhance the coaching relationship, client agrees to communicate honestly, be open to feedback and assistance and to create the time and energy to participate fully in health coaching services.

5. The client agrees to engage in an at-will health coaching program via virtual meetings or the self-paced course with The Pain Brain LLC. For 1:1 sessions, the Health Coach will be available to Client through the secure client portal between scheduled meetings as defined by the health coach. Client may expect secure communications via the client portal within one to two days of their request.

6. Client takes full responsibility for their own well-being and all decisions made before, during and after the health coaching services provided by the health coach. All information and health coaching services provided to the client are made available to the client for the client's own use and for informational and educational purposes only. Client assumes the risk of the health coaching services provided by The Pain Brain LLC, whether or not such risks were created and/or exacerbated by our services.

7. The client understands that no guarantees have been made to me as to the results of health coaching services.

8. The client affirms that they alone are responsible to decide whether to practice health coaching and hereby agrees to irrevocably waive, release and discharge any claims and/or liabilities for death or personal injury or damages of any kind that I have now or hereafter may have against The Pain Brain LLC. I agree not to sue any of the persons or entities listed for any of the claims or liabilities that I have waived, released or discharged herein.

Intellectual Property Rights

Health Coach retains all ownership rights to materials provided to the Client. The materials provided are for the Client's use only and are being provided to the Client with a single-user license. Client is not authorized to record, share, copy, distribute or otherwise disseminate any materials received from the Health Coach electronically or otherwise. All intellectual property including that shared in the virtual interactions shall remain the sole property of the Health Coach, and no license to sell or distribute the Health Coach's Health Coach's materials is hereby granted or implied. Client agrees not to reproduce, copy, duplicate, sell, trade, resell and/or exploit for any commercial or personal purposes any materials provided by Health Coach to Client without Health Coach's prior written consent.

Termination

Client further acknowledges that the Client may terminate or discontinue the health coaching relationship at any time upon submission of written notification via e-mail to The Pain Brain LLC. Please know that if you miss a scheduled appointment and do not attempt to reschedule within 120 days, we will take that as your notice that you have decided to terminate services with The Pain Brain LLC, and another consultation would be required to re-engage in services.

Disclosure

Client has chosen to work with health coach or the self-paced course materials and understands that the information received should not be seen as medical advice and is not meant to take the place of seeing licensed health professionals.

Session Cancellation Policy

Generally, payment is due at the time the visit is scheduled in the Client portal. You will be expected to pay for your scheduled session unless you provide greater than 24 hours notice of cancellation in which case the fee will be refunded. Clients are welcome to reschedule a health coaching session as needed if they are not within 24 hours of the scheduled visit. Clients will not be refunded for the missed visit/cancellation if the session is rescheduled within 24 hours of your session.

Communication

The Pain Brain LLC is often not immediately available by telephone or email. We do our best to return calls, but if we are unavailable, clients have the option to leave a voicemail or send a message through the secure client portal. We will make every effort to return your message as soon as possible, usually within 24 hours, with the exception of weekends and holidays. If you are difficult to reach, please inform us of times when you will be available. If you are unable to reach us and it is an emergency or crisis, call 911 or go to the nearest emergency room to receive immediate care. If we become aware of an emergency, or if we are concerned about your or another person’s safety, we may need to call your emergency contact, or 911 to report our concerns.

Confidentiality and Professional Records

In general, the privacy of all communications between The Pain Brain LLC and a client will remain confidential. However, there are some situations in which we are legally obligated to take action to protect others from harm, even if we have to reveal some information about a client’s treatment. For example, if we believe there is ongoing abuse or neglect of vulnerable person, we are obligated to file a report with the appropriate state agency. If we believe that a client is threatening serious bodily harm to another, The Pain Brain LLC may feel compelled to take
protective actions such as, but not limited to contacting the police or seeking hospitalization for client. If the client threatens to harm himself/herself, we may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection. These situations are rare, however, if they do occur, The Pain Brain LLC will make every effort to fully discuss it with you before taking any action.

1. Most communication between The Pain Brain LLC and the client should occur through
the HIPPA compliant client portal. However, it is important to note that there are limitations of confidentiality when            communicating through email. Although we are open to communication through email for specific reasons and will do our best to maintain your confidentiality, there is always a risk due to viruses, hackers, etc. Therefore, if you choose to communicate with us through email, you accept and assume all associated risks.

2. The Pain Brain LLC will keep records of your services and these records will remain confidential. Your information will not be shared without a signed release of information provided.

Professional Fees and Billing

Payment for services is an important part of your work with The Pain Brain LLC. We provide health coaching services on a fee-for-service basis. Payment in full is expected at the time of session. At this time, The Pain Brain LLC does not offer payment plans. We accept electronic payment by card.

Minors

For the time being, The Pain Brain LLC does not offer services to minors considered those under 18 years of age. 

Entire Agreement

This document reflects the entire agreement between The Pain Brain LLC and the Client. This agreement supersedes all prior oral and written representations. The agreement may not be amended or supplemented except in writing signed by the Pain Brain LLC and the Client.

Waiver

The failure of either party to enforce any provision of this agreement shall not be construed as a waiver or limitation for subsequent enforcement and compliance with all other provisions in this agreement. 

Acknowledgements:

• I acknowledge that I have received, have read, and understand the information about the health coaching services I will undertake. I have had all my questions answered fully, and agree to abide by the terms outlined above.

• I affirm that I will answer all questions pertaining to my medical conditions truthfully.

• I assume all risks of the recommendations made by my The Pain Brain LLC including the risks inherent in revisiting traumatic events and making lifestyle changes.

• I understand that using health coaching services at The Pain Brain LLC is not a form of medical or mental health care and that I can stop services at any time with proper notice.