INFORMED CONSENT FORM & TERMS FOR NUTRITIONAL COUNSELING

I am employing the Nutritional services of Strength and Dignity Dietetics, LLC so that I can obtain information and guidance about health factors within my own control (diet, nutrition, and related behaviors) in order to nourish and support my health and wellness. I understand that Kassidy Wren, RDN, LDN is a Registered Dietitian/Nutritionist and does not dispense medical advice nor prescribe treatment. Rather, she provides education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviors associated with eating. While nutritional and botanical support can be an important complement to my medical care, I understand nutrition counseling is not a substitute for the diagnosis, treatment, or care of disease by a medical provider. Nutritional evaluation provided during counseling or over the course of the weight-loss program is not intended for the diagnoses of disease. Rather, these assessments are intended as a guide to developing an appropriate health-supportive program for me, and to monitor my progress in achieving my goals. I understand that Kassidy Wren, RDN, LDN will keep notes as a record of our work together. These notes document the topics that we talk about, interventions used, and nutritional plan or any other considerations that may be helpful to your work with me. Records will be stored in a secure location. Medical and personal information and history divulged in session to Kassidy Wren, RDN LDN will be kept strictly confidential unless I consent to sharing my medical and nutritional information by way of a signed release. I agree to hold Kassidy Wren, RDN, LDN harmless for claims or damages in connection with our work together. I understand that results are not guaranteed and that my success is based upon my own efforts put in. This is a contract between myself and Kassidy Wren, RDN KDN, and I understand that it is also a release of potential liability.

I understand that Strength and Dignity Dietetics has a 24-hour cancellation policy. Payment is due upon booking an appointment. Cash, check and major credit cards are accepted via electronic means. I am aware that no refund will be given for a consultation if an appointment is missed without proper notice given (by phone or email) within 24 hours prior to the appointment time. All appointments may be rescheduled with no penalty if proper notice is given within 24 hours of the appointment time. No refunds will be given once a consultation has begun. I also understand that there is no refund for the weight loss program once the initial consultation has been had. All sales are final for purchasing menus or accountability packages. Nutrition counseling services may be terminated at the discretion of Kassidy Wren, RDN, LDN if written notification is provided to a client 30 days in advance of final appointment. This will include a referral for continuity of care.
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