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Balance Your Wellness will provide me with nutritional evaluation, coaching, and support for the purpose of enhancing my health. I understand it is not intended as a diagnosis, treatment, prescription, or cure for any mental or physical disease and is not intended as a substitute for regular medical care. In nutrition coaching, no medical procedures are performed, and medications are not prescribed. I understand that Nutrition Coaching services will be provided by Jenna Norton, who is a Master Nutrition and Wellness Coach and has completed her Master’s of Public Health and Bachelor of Food Science and Human Nutrition at The University of Maine. I understand that Jenna Norton is not a Registered Dietitian, and I should discuss any recommendations made by Balance Your Wellness Nutrition with my primary care physician. I release Balance Your Wellness from any liability for my health issues. I have truthfully completed the Client Intake Form for Healthy Balance Your Wellness and listed all my known physical and medical conditions and any medications and supplements I am taking. I will keep Balance Your Wellness informed of any changes. I agree to pay Balance Your Wellness rates outlined in the attached fee schedule. Balance Your Wellness does not accept health care insurance. Balance Your Wellness is covered by liability insurance applicable to any injury caused by an act or omission by providing alternative health care services. This agreement and release are being signed voluntarily and not under duress of any kind.