Indomitable Spirit, LLC dba Janell Kaplan
Informed Consent for Coaching Advocacy
I hereby give my voluntary and informed consent for wellness coaching by Janell Kaplan and Indomitable Spirit, LLC. A wellness coach is a health and wellness professional trained in the use of natural means to advance health and wellness, including education about nutritional strategies, herbal and homeopathic remedies, lifestyle modifications and a range of other natural strategies. An advocate is a health and wellness professional who advocates within the health care team in the interests of the Client, provides the Client with relevant educational materials, informs Client of the options and choices, and facilitates the selection of healthcare team members.
I understand that wellness coaching and patient advocacy are not a regulated industry, and as such, Janell Kaplan is not a licensed or qualified healthcare provider.
I understand Janell Kaplan is a Bachelor of Science in Health Sciences with Psychology (BS), Integrative Health and Wellness Coach, Patient Advocate, Board Certified Massage Therapist (BCTMB), Licensed Massage Therapist (LMT), CranioSacral Therapist (CST), SomatoEmotional Release (SER) Practitioner, Corrective Exercise Specialist (CES), and NOT a Medical Doctor (MD), Doctor of Osteopathy (DO), [Board Certified] Naturopathic Doctor (ND), Registered Dietitian (RD) or Certified Nutritionist (CN).
I understand that although Janell Kaplan has extensive health and wellness training and experience, she cannot and does not diagnose medical conditions, prescribe medical treatments, provide personal care, psychiatric care or counseling, transportation services, or financial, bill payment or insurance counseling.
I understand that if I am experiencing signs and symptoms, or have reason to believe a medical condition exists, I should contact my MD, DO or [Board Certified] ND. And I understand that if I require emergency care, I should call 911, or go to the nearest emergency room.
I understand that it is in my best interest make Janell Kaplan aware of all medical conditions and pregnancy, as some of the natural strategies may present a risk. And I understand that, as with any method of care, natural strategies can involve some risk.
I understand that interactions between herbs and drugs my primary care may prescribe are not yet well known, and that although unlikely, adverse reactions are possible. And I understand I should let my physician know about what herbs I am taking, particularly prior to surgery.
I understand that wellness coaching and patient advocacy services are intended for educational purposes only, and are NOT to be misconstrued as medical advice.
I hereby authorize wellness coaching and patient advocacy services, and certify that I understand the nature of these wellness methods, including the risks. I understand that no recommendations are being made to discontinue any treatment being provided by a licensed or qualified healthcare provider. I represent that I am seeking wellness coaching and/or patient advocacy in order to further my own health and wellness, and do not represent a third-party. I am aware I may withdraw this consent and discontinue following the recommendations at anytime.
This consent will remain in force until revoked in writing. It may be revoked in writing at anytime.