• Sunrise

    Loving Ourselves to Total Wellness

  • Sunrise

    Loving Ourselves
    to Total Wellness

  • Sunrise

    to Total

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

Step 1 – Signature

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.