CLIENT AGREEMENT Effective 11/01/2023
INFORMED CONSENT FOR HEALTH AND LIFE COACHING & CONSULTING SERVICES
Barzilai Consulting and the brands, “Healthspan Coaching,” and “Outlive Coaching” are intellectual property, products, and service lines owned by Healthspan Coaching LLC.
I, (“Client”) voluntarily understand, acknowledge, and agree to the following with respect to the health and life coaching and consulting services rendered by Healthspan Coaching LLC, and its employees (including David Barzilai), associates, technical assistants, agents, and other service providers (collectively, “Provider”).
1. Limitation to Services. David Barzilai is licensed as a medical doctor in Massachusetts, but he is operating in the capacity of a health and life coach and consultant only, and, he is not necessarily relying on his medical license in offering the services described herein. Thus, the services contemplated hereunder are considered alternative or complementary to licensed healing arts services.
2. Description/Nature of Services: The nature of the services Provider will offer includes life coaching and consulting and health coaching and consulting, as described below:
Health and life coaching includes guiding, assisting, educating, and supporting clients to make thoughtful, manageable personal choices to achieve better health and wellness. Provider primarily guides, assists, educates and supports clients to assume more personal responsibility for their health and life trajectory. Provider helps clients clarify, identify, and overcome obstacles. Coaches help clients manage health by sharing their knowledge and experience, and by applying evidence-based approaches and frameworks. Discussions may include but are not limited to supplements, pharmaceuticals, health products/services, lifestyle choices, and health habits. Discussions are not a substitute for medical care with a physician. Provider does not diagnose, treat, cure, or prevent any illness, ailment, symptom, or disease state Provider is not a registered or licensed dietician, nutritionist, therapist, or psychologist in any state. Client understands that any and all nutritional and mindset coaching are not intended as diagnosis, treatment, or prescription and is based solely on Provider’s personal research.
Health consulting includes engaging in educational discussion on the strengths and weaknesses of research that may have bearing on human health. It also may involve discussion and analysis of the evidence base on which different health-related interventions are used (including but not limited to dietary supplements, pharmaceuticals, health products/services, and lifestyle choices). Such educational discussion is general in nature, analyzing in broad terms the evidence for and against different interventions. Health consulting never involves providing personalized recommendations of the health-related interventions discussed. Life consulting involves engaging in stimulating and creative interactions about Client’s personal, professional, and/or business goals to create a plan for achieving those goals. Accordingly, life consulting attempts to maximize Client’s personal potential, leadership abilities, professional development, positive relationships, and quality of life.
3. Theory: The theory upon which the services are based is as follows: (1) health and life coaching involves attuning the Client to their own health and life goals, metrics, and habits, so clients can release limiting beliefs, clarify their values, and achieve overall self-improvement; (2) health and life consulting is based on the idea that a more informed and aware individual can make better personal decisions for themselves and involves partnering with Clients in a thought-provoking and creative process that inspires them to maximize their health, personal, and professional potential.
4. Education, Training, Experience: David Barzilai is a medical doctor (MD) and graduate of Case Western Reserve University (CWRU). At CWRU he also completed a PhD in Health Services Research which provides a broad research background helpful to interpreting basic and clinical research pertinent to health. As an undergraduate, David Barzilai also obtained a BA in Health and Society with broad exposure to health and wellbeing, and a BS in Cell and Developmental Biology helpful for interpreting laboratory medicine pertinent to health. David Barzilai also has an (academic) MS in Psychology (Capella) and holds a certificate in positive psychology pertinent to life and wellness coaching and consulting. He holds an MBA (University of Massachusetts) which provides context for business, executive and financial coaching and consulting. He is board certified in dermatology and also completed curriculum and passed the certifying exam by the American Board of Lifestyle Medicine making him a Diplomat (DipABLM). This curriculum has broad exposure to lifestyle medicine including diet, exercise, sleep, stress, and other facets of general wellbeing. He also holds certificates from the Institute for Functional and Nutrition Academy (IFNA) and the Institute for Integrative Nutrition (IIN) the latter of which designates status as an “Integrative Nutrition Health Coach.” David Barzilai has broad expertise in other facets of life and health coaching and consulting including through certificates in Longevity Medicine from the Longevity Medicine Hub. He has avidly followed the life self-improvement, wellbeing, and the healthspan/longevity space for decades and keenly reads and follows the published literature. He has taught a course in evidence-based medicine and uses his relevant background and PhD toward appraising the pertinent current and emergent research in such areas.
5. Benefits, Risks and Alternatives.
A. Benefits of the services provided may include, and are not limited to:
• Helping people with their health and life without the patient-doctor relationship
• Health coaching can potentially help balance and optimize overall health and wellbeing and increase mental clarity
• Health and life coaching can potentially achieve an increase relaxation, ease and feeling of overall well-being, reduction in stress levels, better sleep, discovering limiting personal beliefs, better time management and organization, more effective goal setting, increased energy, and improved motivation.
B. Risks of the services include distress, provocation of mental and physical health issues which require a licensed healthcare provider, muscle strain and other adverse physical reactions to movement/exercise, dissatisfaction with results, and over-relying on life and health coaching and consulting notwithstanding recommendations by Provider, when Client knows Client should see a licensed physician, mental healthcare or other professional, to treat a physical or psychological condition. Client understands that Client is responsible for monitoring his/her own condition throughout the procedures, and should any unusual symptoms occur, Client will cease participation and inform the Provider of such.
C. Alternatives include visiting licensed healthcare clinicians in-person as appropriate, and engaging in self-help techniques.
6. NOTICE TO CALIFORNIA CONSUMERS:
California State law allows any person to provide nutritional advice or give advice concerning proper nutrition--which is the giving of advice as to the role of food and food ingredients, including dietary supplements. This state law does NOT confer authority to practice medicine or to undertake the diagnosis, prevention, treatment, or cure of any disease, pain, deformity, injury, or physical or mental condition and specifically does not authorize any person other than one who is a licensed health practitioner to state that any product might cure any disease, disorder, or condition.
7. No Guarantee: I recognize that Provider cannot guarantee results or any specific outcomes from our work together, such as attaining specific weight loss or career goals, and other metrics. I am solely responsible for any action taken based on my interpretation of any information presented. In general, to embark on a journey of sustainable life and health changes will require a consistent commitment of at least three (3) months, and often much longer. Results are extremely variable, unexpected events happen, and unforeseen challenges arise all the time, and Provider cannot guarantee any results.
8. Right to discontinue services. Client understands that Provider has the right to refuse to continue delivering services at any time for any reason whatsoever.
9. No Medical or Psychological services. Client is not engaging Provider for any medical or psychological services. Client understands that Provider does not diagnose, treat, or claim to cure any medical or psychological condition, and that Provider’s services are not designed to replace conventional treatment methods of medical or psychological conditions. Client also understands that Provider does not offer therapy for emotional or mental disorders. Client is responsible for their own health care decision-making by obtaining any necessary consultations with appropriately licensed health care professionals such as physicians and psychologists.
10. No Emergency Services. Provider has advised me that he does not admit clients to the hospital or coach hospitalized clients, and that I should maintain a relationship with a physician, urgent care, or hospital that is available to provide emergent and urgent care. If I encounter a medical emergency and am not able to obtain care from my primary care physician, I will contact 911 or report to a hospital emergency department.
11. Information and Education Only. The information provided pursuant to these services is educational and informational in nature and is provided only as general information. The information is not intended to create and does not constitute any professional relationship between Provider and me, nor does it create any doctor-patient or any other professional relationship. Even if those providing services display professional licensure or other credentials in the healing arts, or cite clinical trials or other medical literature, they are limited to providing information and education, and are not providing any clinical service. The information provided should not be used for diagnosing or treating a health problem or disease. The information contained in these communications is not comprehensive and does not include all the potential information regarding the subject matter, but is merely intended to serve as one resource for general and educational purposes.
12. Detoxification Risks. Topics of discussion with Provider may include fasting and other forms of detoxification. While Provider may provide information and education about this health intervention, Provider does not and will not recommend any particular intervention. While fasting and detoxification is generally safe, some people may experience a healing crisis, which may be a short period in which symptoms increase or flu-like symptoms occur with mild fever, chills, dizziness or loss of appetite. Such an experience, while unpleasant, can signal the body is effectively detoxifying or undergoing a healing effort. Provider recommends that I contact my primary care physician immediately or dial 911 in the case of a serious reaction.
13. My Responsibility for My Self-Care. Client understands that any inner-directed work or reflection can bring up distressing feelings, images, thoughts and behaviors. Client agrees to seek medical assistance or psychotherapy or any other appropriate physical or mental diagnosis and treatment from a practitioner duly licensed (such as a licensed medical doctor or licensed psychologist) if Client finds that these distressing aspects create a danger for themselves or for others.
14. No Mental Illness. Client acknowledges that Client has not been hospitalized for any psychiatric condition within the last ten (10) years, nor have charges been brought against me based on my behavior.
15. Dietary Supplements. Provider may discuss dietary supplements with Client. Client acknowledges that it is completely at Client's discretion whether Client acts on any use of dietary supplements. Dietary supplements are marketed for general well-being, or as intended to affect the normal structure or function of the human body – for example, “calcium builds strong bones.” Thus, although Provider may recommend dietary supplements with a specific purpose in mind, manufacturers and distributors are prohibited from making drug or therapeutic claims for dietary supplements, and their use is chiefly designed to support general well-being or certain aspects of metabolic function. While most dietary supplements are generally considered safe, efficacy has not been conclusively established; and in some cases, adverse reactions can occur if Client is concurrently using pharmaceutical medications (drugs). For this reason, it is important to keep all of Client’s licensed healthcare practitioners fully informed about all medications and dietary supplements Client may be taking.
16. Herbs & Herbal Supplements. Provider may discuss herbs or herbal supplements with Client. Client acknowledges that that it is completely at Client’s discretion whether Client acts on any use of herbs or herbal supplement. Any herb or herbal supplement has the potential to cause an adverse effect including an allergic reaction which is uncommon. To mitigate the possibility of an allergic reaction, it is important to disclose all allergies and intolerances to Provider. Allergic reactions can include, but are not limited to, contact dermatitis (itchiness, redness, bumps or hives), irritated and itchy mucous membranes (eyes, ears, nose, or throat), swelling in the face (lips, tongue, throat), or an anaphylactic reaction which can be life-threatening. Other adverse effects include nausea, vomiting, diarrhea, constipation, headache, dry mucous membranes, and others, although these are rare. If discomfort or minor concerning symptoms occur, Client will stop taking the herb(s) or supplement(s) immediately and call Provider to discuss possible causes and solutions. If an adverse or serious reaction occurs, Client will stop taking the herb(s) or supplement(s) and call their professional healthcare provider immediately or dial 911.
17. Disclosure of Interest in Sales of Dietary Supplements & Herbs. Provider may offer dietary supplements and/or herbs for sale. These products may be under contractual obligation to be sold at a certain cost. Depending on the situation, products may be sold at a reasonable and customary markup from cost. However, Client is under no obligation to purchase these products from Provider; Client may purchase the same or similar products elsewhere. The quality of services provided by Provider will not be affected by Client’s decision to purchase or not purchase products from Provider.
18. Phone and Digital Communications. Provider may communicate with me over the phone, video (if indicated), email, and various digital platforms. Anticipated benefits include improved access to Provider and allows for Provider and myself to communicate while in different physical locations. Potential risks include gaps of failures in communication, complicating Provider’s furnishing of services, notwithstanding reasonable efforts to ensure the quality and reliability of transmitted information. There may be limitations to image quality or other electronic problems that are beyond the control of Provider. Despite reasonable security measures, online communications can be forwarded, intercepted, or even changed or falsified without my knowledge. Alternatives to using electronic communications include an in-person visit or a visit to a coach/consultant or licensed healthcare professional in my state. In addition, I understand that I may recorded, and I hereby grant Provider the right to record me while I receive services from Provider. I understand and agree that Provider will own all rights in and to such recorded work, including rights granted by copyright law. I further agree not to record, copy, duplicate, repost, publish, or disseminate the same or any portion thereof, by audio, video, photographic or any other means.
19. Assumption of Risk. Client knowingly, voluntarily, and intelligently decide to receive the services described above, and Client knowingly, voluntarily, and intelligently assume all risks involved in the same.
I ACKNOWLEDGE THAT I AM AWARE OF ALL RISKS INHERENT IN RECEIVING HEALTH AND LIFE COACHING AND CONSULTING SERVICES, INCLUDING POSSIBLE INJURY, AND I HEREBY ASSUME ALL RISKS. I HEREBY WAIVE AND RELEASE AND HOLD HARMLESS PROVIDER FROM ANY AND ALL LIABILITIES, LOSSES, DAMAGES AND CLAIMS OF ANY KIND OR NATURE ASSOCIATED WITH INJURIES, OR OTHERWISE ARISING OUT OF OR RELATED TO MY PARTICIPATION IN THE HEALTH AND LIFE COACHING AND CONSULTING SERVICES.
Additionally, Client agrees to release, hold harmless, indemnify, and defend Provider from and against any and all claims which Client (or Client’s representatives) may have for any loss, damage, or injury arising out of or in connection with use of the services described above, or arising out of or in connection with the referral to other practitioners or merchants for delivery of any services.
20. Limitation of Liability. Provider is not liable to me or any third party for any damages (including, without limitation, direct, indirect, incidental, special, consequential, exemplary, incidental, special, or punitive damages, personal injury/wrongful death, lost profits, good will, use data or other intangible losses (whether or not Client has been advised of the possibility of such damages)) or damages arising from or relating to this Informed Consent, even if advised of the possibility of such loss or damages, and whether under negligence or some other theory of liability. Because some states do not allow the exclusion or limitation of liability for consequential or incidental damages, in such states, liability is limited to the fullest extent permitted by law. Notwithstanding the above, Provider’s sole liability for any reason to me, and my sole and exclusive remedy for any cause or claim whatsoever, shall be limited to the amount paid by me for services provided by Provider, and, must be brought within one (1) year since the event giving rise to such action occurred. Client understands and agrees that my participation with respect to receiving services is predicated upon my waiver of any right to participate in a class action suit for any losses or damages resulting from the same.
21. Arbitration. Any dispute, claim, or controversy arising out of or relating to this Informed Consent or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in Boston Massachusetts before one (1) arbitrator. The arbitration shall be administered by AHLA Alternative Dispute Resolution Service Rules of Procedure for Arbitration in Boston, Massachusetts. Judgment on the award may be entered in any court having jurisdiction. This provision shall not preclude either party from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. To the extent permitted by applicable law, the costs of the arbitration shall be borne by the losing party. Each party has read and understood this Section (Arbitration) and understands that it thereby agrees to submit any claims arising out of this Agreement to binding arbitration, and that this dispute resolution provision constitutes a waiver of the Party’s right to a jury trial. HOWEVER, prior to either party initiating Arbitration of any dispute, the parties agree to attempt mediation of the dispute with a mutually agreeable trained mediator in Boston, Massachusetts. “Trained mediator” means a professional with actual training and experience in the field of Mediation and/or dispute resolution. EACH PARTY HAS READ AND UNDERSTANDS THIS SECTION and UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, THE PARTY AGREES TO SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT, OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH, OR TERMINATION THEREOF TO MEDIATION AND ARBITRATION, AND THAT THE DISPUTE RESOLUTION PROVISIONS SET FORTH IN THIS SECTION CONSTITUTE A WAIVER OF THE PARTY’S RIGHT TO A JURY TRIAL.
I have carefully read this form and acknowledge that I understand it. I also acknowledge that I have been provided with a copy of this form. No representations or statements, oral or written, have been made to me, apart from those described in this form. If any portion of this Informed Consent is held invalid, the rest of the document will continue in full force and effect.