Medical Coaching Enrollment Form and Consent Form

In order to participate in the Medical Coaching Sessions, please fill out and sign the following Enrollment and Consent form.

By Signing Below, I hereby represent and agree as follows:

• I am over 18 years of age and currently am under the care of a physician or health care practitioner. The information, instruction or advice given in Medical Coaching is not intended to be a substitute for my current medical or psychological diagnosis and care.
• I understand that no legal physician-patient relationship is established through my participation in Medical Coaching.
• During Medical Coaching Sessions, suggestions will be given to assist me in Loving Myself to Total Wellness, but I understand that I should consult with my physician or other health care practitioner before implementing any of these suggestions.
• I understand that the Small-group Medical Coaching Sessions will be placed on video and given to all participants.
• Cancellation Policy: No refunds will be given. Private Medical Coaching Sessions may be rescheduled only in the case of emergency as long as 24 hours email notice is given. If a Small-group Medical Coaching Session is missed, all participants will receive the class on Video.

Step 1 – Signature | Step 2 – Select Your Package | Step 3 Payment Information

Please fill out the below form no later than 1 week before your scheduled Medical Coaching Session in order to participate.

***For Private Medical Coaching Sessions only: Please list Days and Times that you are available. Dr. Patty will match your available times with her available Coaching times and select a mutually convenient time for your Private Medical Coaching Session. You will receive an email with a confirmation of your Private Medical Coaching Session time once Dr. Patty receives this form.