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The following form is an important legal document. It explains the parameters of the nutrition counseling and wellness coaching to be provided by EvaClaire Synkowski. Please read it carefully and understand it fully before signing.

 

 

 

 

 

 

NUTRITION COUNSELING AND WELLNESS COACHING

ACKNOWLEDGMENT & WAIVER OF LIABILITY

 

 

 

 

EvaClaire Synkowski (d/b/a OptimizeMe Nutrition) is not licensed, certified, or registered by the State of Colorado as a healthcare professional, nor is she subject to licensure, certification, or registration by the State of Colorado. The scope of her services does not include treatment or diagnosis of medical conditions. EvaClaire Synkowski provides nutrition counseling and wellness coaching. You are encouraged to consult with a licensed medical practitioner if you suspect you have an ailment or illness that requires medical attention.

 

 

I voluntarily engage EvaClaire Synkowski to provide nutrition counseling and wellness coaching to support my overall health and wellbeing. I understand that EvaClaire Synkowski does not provide medical advice or prescribe treatment. Rather, she provides information and guidance to enhance my knowledge of health and nutrition as it relates to food, exercise, dietary supplements, and behaviors associated with eating.

 

 

The advice given by EvaClaire Synkowski is based in part on the information provided by me. It is my sole responsibility to provide complete and accurate information. Any misinformation or omitted information may affect EvaClaire Synkowski’s nutritional assessment and recommended wellness plan. 

 

 

Only licensed physicians may prescribe drugs. Any mention of drugs during consultation is simply to provide EvaClaire Synkowski background on the drugs I am taking or have taken. EvaClaire Synkowski will not judge the appropriateness of any medication and I understand that any change in prescription or dosage is a decision I must make with my physician.

 

 

I acknowledge that nutrition counseling and wellness coaching can be an important compliment to medical care. However, I understand and agree that EvaClaire Synkowski’s services are not a substitute for the diagnosis, treatment, and care of a licensed medical practitioner.

 

 

Nutrition counseling and wellness coaching are not exact sciences. I understand and agree that results may vary and achieving a positive outcome depends on many factors within my own control including the effort expended by myself.

 

 

I AGREE TO HOLD EVACLAIRE SYNKOWSKI HARMLESS FOR ANY AND ALL CLAIMS, OR DAMAGES, IN CONNECTION WITH HER NUTRITION COUNSELING AND WELLNESS COACHING, AND I FOREVER RELEASE HER OF ALL POTENTIAL LIABILITY.

 

 

My signature below indicates that: I have carefully read and reviewed this Acknowledgment and Waiver of Liability in its entirety; I fully understand it; and I freely accept the risks and limitations involved in voluntarily seeking the services provided by EvaClaire Synkowski. 

 

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