Exclusive Heart Membership Agreement and Consent Form
Welcome! I am so excited to have you join the Exclusive Heart Membership. Please read the following. If anything is unclear, please ask.
The Exclusive Heart Membership Agreement and Consent Form (hereinafter the “Agreement”) lays out the terms and conditions of participating in the group coaching program (hereinafter the “Program”).
This Agreement is entered between Client (“Client”) and Entirely Nourished, LLC (“Company”). Client understands that Client will be partaking in an Entirely Nourished group Program, and not an individualized medical nutrition therapy or counseling program.
The Program will include the following:
Program Cost, Financial Policy, and Monthly Contract
I agree to enroll in a three month commitment that becomes a monthly Program thereafter. To sign up, I acknowledge there is a one-time $99 USD non-refundable enrollment fee + three monthly payments of $125 USD per month. The first three months are non-refundable, but thereafter, I can terminate my membership to the Program at any time by emailing Michelle at michelle@entirelynourished.com with at least 72 hours notice prior to the next billing cycle.
All monthly charges will reoccur on the consecutive's month date of enrollment. Any contiguous months after enrollment will continue to be charged at $125 USD per month even if prices for this Program have increased elsewhere.
The initial payment will include the enrollment fee of $99 USD unless a coupon code is provided on the checkout page.
This Agreement and billing cycle automatically renews monthly on the date of the Client's initial enrollment date unless Michelle is notified of membership cancellation by email 72 hours prior to the 1st of the month.
Contract pricing between months is not subject to change. Contract pricing between a Termination and re-engagement with Program is subject to change.
Coaching is not considered medically necessary and is not covered by in-network insurance. Payment is requested through credit or debit card transition, including FSA and HSA cards. Please complete the credit card authorization section below to secure your enrollment in the Program.
Termination
This Agreement can be terminated at any time after the first 3 months upon emailing the Company of immediate request to Terminate this Agreement. Upon Termination of this Agreement, Client will lose access to Program benefits. To prevent a future automatic renewal and monthly payment, the Company must be made aware via email of a request to terminate the Agreement at least 72 hours prior to the first of the month.
Credit Card Authorization Section: I, {{client.name}}, authorize, Michelle Routhenstein from Entirely Nourished, LLC (the “Company”), to charge the following credit card monthly for my participation in the Program, with the terms as indicated above.
In the event the credit card is declined, an incremental $25 will be added to cover additional processing fees.
If a credit card is expired or changed, Client will update credit card within Thrivecart or contact Michelle to update appropriately.
No-Show and Cancellation Policy
Live Video sessions may not be rescheduled. Fees are non-refundable. It is understood that Client may not be able to make all of the Live Videos sessions. Live Sessions will be recorded and emailed to Client afterwards. By signing this agreement, Client consents to allow for recording of the Live Sessions to occur where he/she may be shown and recorded on video, that can be shared to the other participants in the group via the closed Facebook group and/or participant emails.
Confidentiality
All information shared during the Program and on the Facebook group is confidential. All information from each Group Client is confidential, with the exception of circumstances governed by law, such as child abuse and danger posed to self or others. All Group Clients identities are confidential. All parties agree to take all reasonable measures to ensure confidentiality of Group Clients and communications over the phone and/or Internet.
Liability Release
I have read and understood this contract, and I agree to the terms of this Agreement. I acknowledge that the Company can make no guarantee or warranty as to the results of the Program. I release the Company of all liability as to my personal results of this program. I understand that my results may not meet my desires, and that weight loss and optimizing of laboratory parameters, as a lifestyle change, takes time. I therefore release the Company from all liability as to my personal results from this Program.
The Exclusive Heart Membership Agreement and Consent Form (hereinafter the “Agreement”) lays out the terms and conditions of participating in the group coaching program (hereinafter the “Program”).
This Agreement is entered between Client (“Client”) and Entirely Nourished, LLC (“Company”). Client understands that Client will be partaking in an Entirely Nourished group Program, and not an individualized medical nutrition therapy or counseling program.
The Program will include the following:
- 1-Hour Live Video: On the fourth Tuesday of every Month at 8pm EST (subject to change as needed), there will be a 1-hour live video session via Zoom. All sessions will be recorded and provided to the group to watch at their convenience, if you cannot make it live.
- Facebook Group: A closed Facebook group that allows for questions, peer support, updates, and science based advice moderated by Michelle Routhenstein, MS RD CDE CDN.
Program Cost, Financial Policy, and Monthly Contract
I agree to enroll in a three month commitment that becomes a monthly Program thereafter. To sign up, I acknowledge there is a one-time $99 USD non-refundable enrollment fee + three monthly payments of $125 USD per month. The first three months are non-refundable, but thereafter, I can terminate my membership to the Program at any time by emailing Michelle at michelle@entirelynourished.com with at least 72 hours notice prior to the next billing cycle.
All monthly charges will reoccur on the consecutive's month date of enrollment. Any contiguous months after enrollment will continue to be charged at $125 USD per month even if prices for this Program have increased elsewhere.
The initial payment will include the enrollment fee of $99 USD unless a coupon code is provided on the checkout page.
This Agreement and billing cycle automatically renews monthly on the date of the Client's initial enrollment date unless Michelle is notified of membership cancellation by email 72 hours prior to the 1st of the month.
Contract pricing between months is not subject to change. Contract pricing between a Termination and re-engagement with Program is subject to change.
Coaching is not considered medically necessary and is not covered by in-network insurance. Payment is requested through credit or debit card transition, including FSA and HSA cards. Please complete the credit card authorization section below to secure your enrollment in the Program.
Termination
This Agreement can be terminated at any time after the first 3 months upon emailing the Company of immediate request to Terminate this Agreement. Upon Termination of this Agreement, Client will lose access to Program benefits. To prevent a future automatic renewal and monthly payment, the Company must be made aware via email of a request to terminate the Agreement at least 72 hours prior to the first of the month.
Credit Card Authorization Section: I, {{client.name}}, authorize, Michelle Routhenstein from Entirely Nourished, LLC (the “Company”), to charge the following credit card monthly for my participation in the Program, with the terms as indicated above.
In the event the credit card is declined, an incremental $25 will be added to cover additional processing fees.
If a credit card is expired or changed, Client will update credit card within Thrivecart or contact Michelle to update appropriately.
No-Show and Cancellation Policy
Live Video sessions may not be rescheduled. Fees are non-refundable. It is understood that Client may not be able to make all of the Live Videos sessions. Live Sessions will be recorded and emailed to Client afterwards. By signing this agreement, Client consents to allow for recording of the Live Sessions to occur where he/she may be shown and recorded on video, that can be shared to the other participants in the group via the closed Facebook group and/or participant emails.
Confidentiality
All information shared during the Program and on the Facebook group is confidential. All information from each Group Client is confidential, with the exception of circumstances governed by law, such as child abuse and danger posed to self or others. All Group Clients identities are confidential. All parties agree to take all reasonable measures to ensure confidentiality of Group Clients and communications over the phone and/or Internet.
Liability Release
I have read and understood this contract, and I agree to the terms of this Agreement. I acknowledge that the Company can make no guarantee or warranty as to the results of the Program. I release the Company of all liability as to my personal results of this program. I understand that my results may not meet my desires, and that weight loss and optimizing of laboratory parameters, as a lifestyle change, takes time. I therefore release the Company from all liability as to my personal results from this Program.
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