Electronic Acknowledgment by the Client
Envision Your Wellness Coaching Contract
This Agreement is entered into by and between: Elizabeth Shanika Esparaz M.D. (Coach) and ______ (Name of Client) whereby Coach agrees to provide Coaching Services for Client.
Description of Coaching: Coaching is a partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client in a thought-provoking and creative process that inspires the client to maximize personal and professional potential. It is designed to facilitate the creation/development of personal, professional, or business goals and to develop and carry out a strategy/plan for achieving those goals.
Coach-Client Relationship
The Coach agrees to maintain the ethics and standards of behavior established by the International Coach Federation (ICF) (Coachfederation.org/ethics). It is recommended that the Client review the ICF Code of Ethics and the applicable standards of behavior. The Client is solely responsible for creating and implementing their own physical, mental, and emotional well-being, decisions, choices, actions, and results arising out of or resulting from the coaching relationship and their coaching calls and interactions with the Coach. As such, the Client agrees that the Coach is not and will not be liable or responsible for any actions or inaction, or for any direct or indirect result of any services provided by the Coach. The Client understands that coaching is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease. The Client further acknowledges that they may terminate or discontinue the coaching relationship at any time. The Client acknowledges that coaching is a comprehensive process that may involve different areas of their life, including work, finances, health, relationships, education, and recreation. The Client agrees that deciding how to handle these issues, incorporate coaching principles into those areas, and implementing choices is exclusively the Client’s responsibility. The Client acknowledges that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical, or other qualified professionals. It is the Client’s exclusive responsibility to seek such independent professional guidance as needed. If the Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider of the nature and extent of the coaching relationship agreed upon by the Client and the Coach. The Client understands that in order to enhance the coaching relationship, the Client agrees to communicate honestly, be open to feedback and assistance, and create the time and energy to participate fully in the program.
Services
The parties agree to engage in a 2-month Coaching Program conducted virtually.
Confidentiality
This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Coach as part of this relationship, is bound by the principles of confidentiality set forth in the ICF Code of Ethics. However, please be aware that the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and thus communications are not subject to the protection of any legally recognized privilege. The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent. Confidential Information does not include information that: (a) was in the Coach’s possession prior to its being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Coach from a third party, without breach of any obligation to the Client; (d) is independently developed by the Coach without use of or reference to the Client’s confidential information; or (e) the Coach is required by statute, lawfully issued subpoena, or by court order to disclose; (f) is disclosed to the Coach and as a result of such disclosure the Coach reasonably believes there to be an imminent or likely risk of danger or harm to the Client or others; and (g) involves illegal activity. The Client also acknowledges his or her continuing obligation to raise any confidentiality questions or concerns with the Coach in a timely manner.
Record Retention Policy
The Client acknowledges that the Coach has disclosed their record retention policy with respect to documents, information, and data acquired or shared during the term of the Coach-Client relationship. Such records will be maintained by the Coach in a format of the Coach’s choice (print or digital/electronic) for a period of not less than 1 year.
Termination
Either the Client or the Coach may terminate this Agreement at any time with 2 weeks written notice. The Client agrees to compensate the Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship.
Limited Liability
Except as expressly provided in this Agreement, the Coach makes no guarantees, representations, or warranties of any kind or nature, express or implied, with respect to the coaching services negotiated, agreed upon, and rendered. In no event shall the Coach be liable to the Client for any indirect, consequential, or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to the Coach under this Agreement for all coaching services rendered through and including the termination date.
Entire Agreement
This document reflects the entire agreement between the Coach and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered, or supplemented except in writing signed by both the Coach and the Client.
Dispute Resolution
If a dispute arises out of this Agreement that cannot be resolved by mutual consent, the Client and Coach agree to attempt to mediate in good faith for up to 30 days after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.
Severability
If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
Waiver
The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.
Applicable Law
This Agreement shall be governed and construed in accordance with the laws of the State of Ohio, without giving effect to any conflicts of laws provisions.
Binding Effect
This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns.
Please sign both copies and return one copy of this Client Agreement prior to the first scheduled coaching meeting. Retain one copy for your records and mail the other to: [Insert mailing address]
Coach: Elizabeth S. Esparaz M.D., 6551 Wilson Mills Road, Mayfield Village OH
Signature: Elizabeth S. Esparaz M.D.
Health Disclosures:
Before participating in the group health and wellness program, it is important to consider your current health status. If you have not been regularly exercising or have any underlying health conditions, it is strongly recommended that you consult with your physician or a qualified healthcare professional to ensure you are in good health and able to safely engage in a fitness regimen. This is particularly important if you have any pre-existing medical conditions, injuries, or concerns that may affect your ability to engage in physical activities.
Please note that the group health and wellness program is not a substitute for professional medical advice, diagnosis, or treatment. The program is designed to provide general guidance and support for individuals looking to improve their overall health and well-being. It is always recommended to seek appropriate medical advice and supervision when making significant changes to your exercise routine or overall health practices.
Results Disclosure:
While participating in the group health and wellness program, it is important to recognize that individual results may vary. The program offers guidance, support, and resources to help you work towards your fitness goals, but it does not guarantee specific outcomes or results. The level of success you experience in achieving your fitness goals will depend on various factors, including your commitment, effort, consistency, and individual circumstances.
It is important to maintain realistic expectations and understand that progress may occur at different rates for different individuals. The program encourages active participation and consistent effort to maximize the potential benefits. However, it is important to remember that there are no guarantees of specific results or outcomes.
By participating in the group health and wellness program, you acknowledge and understand that your individual results may vary. The program provides tools, education, and support to help you make positive changes to your health and fitness, but the ultimate responsibility lies with you. Your commitment, dedication, and consistency in following the program will greatly influence your progress towards your desired goals.
Remember, the more actively you engage and participate in the program, the more likely you are to experience positive changes and improvements in your overall health and well-being.
By signing, I understand the risks and responsibilities of participating in this group health coaching program.
COPYRIGHT DISCLOSURE AND CONFIDENTIALITY AGREEMENT
I, hereby acknowledge and agree to the following terms and conditions regarding the copyright protection and confidentiality of materials provided by Elizabeth S. Esparaz M.D., LLC:
Copyright Ownership:
All materials, including but not limited to documents, reports, designs, software, and any other intellectual property, provided by Elizabeth S. Esparaz M.D., LLC are protected by copyright laws and other applicable intellectual property rights. Elizabeth S. Esparaz M.D., LLC retains full and exclusive ownership of all copyrights and intellectual property rights related to the provided materials.
Restricted Usage:
I understand and agree that the materials provided by Elizabeth S. Esparaz M.D., LLC are for internal use by [Client Company Name] only. I will not reproduce, distribute, modify, or create derivative works based on the materials without prior written consent from Elizabeth S. Esparaz M.D., LLC.
Confidentiality:
I acknowledge that the materials provided by Elizabeth S. Esparaz M.D., LLC may contain proprietary or sensitive information, including trade secrets, processes, strategies, or other confidential information. I agree to maintain the strictest confidentiality regarding these materials and will take all necessary measures to prevent unauthorized access, use, or disclosure.
Non-Disclosure:
I will not share the materials provided by Elizabeth S. Esparaz M.D., LLC with any third parties, including but not limited to competitors, consultants, or contractors, without obtaining prior written consent from Elizabeth S. Esparaz M.D., LLC. I will not use the materials in any manner that may harm or negatively impact Elizabeth S. Esparaz M.D., LLC or its business interests.
Legal Compliance:
I understand that unauthorized distribution, reproduction, or use of copyrighted materials may infringe upon intellectual property laws and expose both Client and Elizabeth S. Esparaz M.D., LLC to legal consequences. I agree to comply with all applicable copyright and intellectual property regulations.
Term:
This agreement shall remain in effect for the duration of our business relationship and will survive termination or completion of any project.
By signing below, I acknowledge that I have read and understood the terms and conditions outlined in this Copyright Disclosure and Confidentiality Agreement. I agree to abide by these terms and undertake to ensure compliance within my organization.
Accepted and Agreed by:
Elizabeth S. Esparaz M.D., LLC