CLIENT AGREEMENT

THIS AGREEMENT is made as of %DATE% between Eat Well. Perform Better LLC (“Dietitian”) and %CONTACT_NAME% (collectively as the “Parties”).

The Parties have agreed that Client would like to retain Dietitian to provide services for Client, which is more fully described in Exhibit A (the “Services”). The Parties agree to the following:

  1. Term. This Agreement shall be effective as of the date listed above and shall continue until written notice of Termination from either Party OR until completion of the Services outlined in Exhibit A.

  2. Representations and Warranties.The Parties represent and warrant the following:

    1. Dietitian represents and warrants that:

      1. Dietitian is a Registered Dietitian and is qualified to perform the Services; 

      2. Dietitian will provide the Services in a timely, diligent, professional, and workmanlike manner, in accordance with the Agreement and in a manner consistent with industry standards; 

      3. Dietitian will perform the Services in compliance with all applicable laws and regulations; and,

      4. Dietitian has the full and unrestricted right, power, and authority to enter into this Agreement, perform the Services, and grant the rights granted herein. Dietitian has no other agreements with any other party that would conflict with this Agreement. 

    2. Client represents and warrants that: 

      1. Client will provide the information needed by Dietitian to perform the Services, as described herein; and,

      2. Client has the full and unrestricted right, power, and authority to enter into this Agreement and grant the rights granted herein. Client has no other agreements with any other party that would conflict with this Agreement.

  3. Changes and Revisions. This Agreement is limited to the Services outlined in Exhibit A. If Client requests new work or changes that are outside the original scope of the Services, Dietitian will provide an estimate. Additional services may be added and charged based on agreement between Dietitian and Client. 

  4. Compensation and Payment. Client shall pay Dietitian in accordance with the amounts listed in Exhibit A.  In the event that Dietitian incurs legal fees, costs, or disbursements in an effort to collect any Client invoices, in addition to interest on the unpaid balance, Client agrees to reimburse Dietitian for all such expenses.

  5. Expenses. Client shall not be liable to Dietitian for expenses paid or incurred by Dietitian, except for those fees that the Parties agree to in writing. 

  6. Cancellation Policy. Client agrees to notify Dietitian of cancellation of any appointments with a minimum notice of twenty-four (24) hours prior to the scheduled start time, via EMAIL to cortneyberling@gmail.com. If such notification is not received by Dietitian at least twenty-four (24) hours before the scheduled time, payment for that session will be required. 

      1. Neither party shall be liable for delay or failure to attend a scheduled session if such delay or failure is caused by any circumstances beyond their reasonable control. Determination of such reasonableness is in the sole discretion of Dietitian.

  7. Status. The Parties understand and agree that Dietitian is an independent contractor, which may contract with subcontractors for completion of the Services. Neither Dietitian nor Dietitian’s agents shall be entitled to and waive any and all claims to any employee benefits as a result of Client’s relationship with Dietitian. It is understood by the Parties that the relationship established by this Agreement is one of an independent contractor and not an employment relationship, joint venture, partnership, or otherwise. Dietitian is not authorized to enter contracts or agreements or create obligations on behalf of Client to third parties unless otherwise indicated by Client, in writing. 

  8. Termination. This Agreement may be terminated, postponed, or delayed, in whole or in part, by either Party immediately upon written notice to the other party. However, there will be no refunds. 

  9. Confidentiality. The Parties agree that neither party shall authorize the other to disclose to any third party any confidential information without prior written consent, except as may be necessary to establish or assert rights hereunder, as required by the laws of the applicable jurisdiction or by court order. Confidential Information includes business methods, business policies, business strategies, business plans, procedures, techniques, research, or any other relevant details relating to or dealing with the business operations or activities of the Parties. Confidential information is not limited to a specific medium and can be oral, written or physical in format. The confidentiality obligations set forth in this Agreement shall survive 10 years after termination or expiration of the Agreement.

  10. Intellectual Property - Dietitian Materials. All original materials provided by Dietitian to Client are owned by Dietitian. Any original materials are provided for Client's individual use only. Client is not authorized to use or transfer any of Dietitian’s intellectual property. All intellectual property remains the property of Dietitian. No license to sell or distribute is granted or implied.

  11. Disclaimer. Dietitian will provide current dietary and nutrition advice and information as part of the Services. Dietitian has made every effort to ensure that all Services have been tested for accuracy. There is no guarantee that Client will see positive results using the techniques and materials provided by Dietitian. Dietitian assumes no management responsibility for Client's decisions or practices that Client implements.

  12. Medical Treatment. Client understands and agrees that Dietitian provides dietary, nutrition, and wellness information and advice. Client understands that Dietitian does not provide medical advice nor can Dietitian prescribe medical treatment. Client understands that Client must seek medical advice from Client’s physician or medical provider. Client understands that it is Client’s responsibility to discuss all changes to Client’s diet or potential dietary supplement use with Client’s medical provider prior to making any changes. 

  13. Waiver. Client understands that all changes to Client’s diet, including changes to food or use of dietary supplements, carries a risk. Client is doing this at Client’s risk. Client is engaging Dietitian for Services with full knowledge and acceptance of such risks. Client hereby releases Dietitian from any and all responsibility or liability from injuries or damages to Client’s person resulting from or connected with Client’s participation in the Services.

  14. Indemnification. Dietitian agrees to defend, indemnify and hold Client, its affiliated companies and its respective employees, officers, directors, trustees and agents harmless from and against any and all losses, claims, suits, actions, liabilities, obligations, costs and expenses (including reasonable attorneys’ fees and costs) which they suffer as a result of (i) the negligence or intentional misconduct of Dietitian or (ii) Dietitian's breach of any provision of this Agreement (including any representation or warranty). Client shall indemnify, defend, and hold Dietitian harmless from and against any loss, liability, damage, or expense, including reasonable attorney's fees, incurred or suffered by or threatened against Dietitian in connection with or as a result of any claim brought by or on behalf of any third party person or entity as a result of or in connection with Dietitian’s appearance or association with Client, unless such claim arises from Dietitian’s acts or omissions or arises from or is related to breach of any obligation and/or warranty made by Dietitian hereunder.

  15. No Warranty. All information is provided "as is" with no warranties.

  16. Choice of Law and Jurisdiction. This Agreement shall be governed by the laws of the State of which the client resides in without regard to its conflict of laws doctrine, and applicable federal laws of the United States of America. 

  17. Assignment. This Agreement shall not be transferred or assigned to any third party, in whole or in part, by Client without the express written consent of Dietitian, which may be withheld in Dietitian’s sole discretion. 

  18. Notice. Except as otherwise provided herein, all notices that either party is required or may desire to give the other party shall be in writing to the addresses in the signature block. Electronic mail is permissible, but will only be considered sufficient notice if the non-sending party affirmatively confirms receipt. 

  19. Miscellaneous. 

    1. If any of the provisions of this Agreement is or becomes illegal, unenforceable, or invalid (in whole or in part for any reason), the remainder of this Agreement shall remain in full force and effect without being impaired or invalidated in any way. 

    2. Any rights or obligations contained herein that by their nature should survive termination of the Agreement shall survive, including, but not limited to representations, warranties, intellectual property rights, indemnity obligations, and confidentiality obligations.

    3. Any failure of either party to enforce any provision of this Agreement, or any right or remedy provided for therein, shall not be construed as a waiver, estoppel with respect to, or limitation of that party’s right to subsequently enforce and compel strict compliance or assertion of a remedy.

    4. The Agreement may be executed in several counterparts, all of which taken together will constitute one single agreement between the Parties. The Parties expressly agree that with respect to this Agreement, a facsimile or electronic signature or executed document which has been formatted as a Portable Document Format (PDF) and electronically exchanged shall be binding upon the Parties. 

    5. This Agreement, along with all attachments, represents a single agreement, as well as the entire agreement with respect to the subject matter. This Agreement supersedes any prior agreement between the parties, whether written or oral, with respect to the subject matter, and may be modified or amended only by a writing signed by the party to be charged. 

EXHIBIT A

DESCRIPTION OF SERVICES

Objective: Provide education and nutrition coaching in regard to the foods an individual should be consuming for the body to function at its ultimate capacity. Coaching will be focused on creating sound eating habits to meet the energy demands of endurance training and creating a positive mindset around food choices.

Timeline: One time visit.

Location of Services: Virtual (Zoom)

Compensation: Self-Pay

Client will pay the following fees for the Service prior to the scheduled visit: $150 for initial appointment 

Communication: Dietitian approves reasonable communications through the following channel: email. All communications regarding the Services will be conducted only on this approved channel. Client understands and acknowledges that messages sent in any format, other than the approved channels, without prior approval from Dietitian will not receive a response. Client should allow two (2) business days for a response to all communications; however, most responses will be received within one (1) business day.

Description of Services: 

  1. The Registered Dietitian will meet with the client virtually (via Zoom) for 60 minutes. The Registered Dietitian will review all forms, discuss current dietary habits and physical activity. The client may be asked to keep a food log for the Registered Dietitian to review. The client and Registered Dietitian will set goals centered around overcoming the clients biggest nutritional concerns. 

Cortney Berling, MPH, RD

Cortneyberling@gmail.com

216-408-2226

745 Ledge Rd. Hinckely, OH 44233

Assumption of Risk and Release of Liability

I hereby acknowledge and agree:

1.     The purpose of run coaching is to improve the overall health, vitality and well-being of the body through  exercise. The coach, Cortney Berling, does not diagnose diseases, disorders or conditions.

2.     The Running Coach, Cortney Berling, is a Licensed Dietitian and Registered Dietitian, but she is not Naturopathic Doctor or Medical Physician.

3. As part of the run coaching Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. This information is collected to enable the the coach to: (i) assess my knowledge of nutrition, (ii) education me about the benefits of sound nutritional practices and (iii) recommend dietary changes to improve my general health, vitality and overall

well-being. The coach, Cortney Berling will hold this information in confidence and will not release or disclose this information to any other person, without my prior consent, except as required by applicable law.

4.     If the coach, Cortney Berling, suspects the existence of disease, disorder or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis or conclusion about the state of my health and that I am directed to promptly consult a licensed Physician or Naturopath about any suspected problems.

5.     In providing run coaching services to me, the coach, Cortney Berling, is relying upon the truth, accuracy and completeness of all information I have provided to her. Any recommendations I follow for changes in exercise and diet are entirely my responsibility.

6.     Cortney Berling is in no way liable for my health or safety.

7.     In consideration of my participation in the run coaching services, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release the the coach, Cortney Berling, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in the run coaching services, whether caused by negligence or otherwise.

8.     I understand that any therapies I undertake at Eat Well. Perform Better are undertaken on my own free will. I accept that the ultimate responsibility for my health care is my own and that Eat Well. Perform Better is here to support me in this. I understand that my practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended. I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of same and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation. I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.

9. I agree to pay $150/month on the 15th of every month until written notice given by either party.

HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed by Eat Well. Perform Better and how you can get access to this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record 

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 

  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us directly at:

  • Eat Well. Perform Better

  • cortneyberling@gmail.com

  • [216-408-2226]

  • You can file a complaint with the U.S. Department of Health and Human Services Office Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling , calling 1-877-696-6775.

  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation 

  • Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services. 

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services. 

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

  • We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

This Notice is effective as of the date that this document is signed.