• Sunrise

    Loving Ourselves to Total Wellness

  • Sunrise



    Loving Ourselves
    to Total Wellness

  • Sunrise

    Loving
    Ourselves
    to Total
    Wellness

Medical Coaching Enrollment and Consent Form

In order to participate in the Medical Coaching Sessions, please fill out and sign the following Enrollment and Consent form. You may cut and paste it and email it to me before our first session at info@pattybilhartz.com.
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.
  • 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.
  • Name_________________________Date of Birth__________________

    Email________________________Phone_________________________

    Address____________________________________________________

    Signature_____________________________Date__________________

    Days and Times Available____________________________________