Client Disclosure
This Client Disclosure & Agreement, dated as today of 2019 between Coach Heller, LLC, a California limited liability company (“CH”) and an individual (“Client”), regarding Client’s participation in CH’S program.
I. Zero Pain Now PROCESS
A Zero Pain Now practitioner uses their best effort and will guide the Client through the 28-day Zero Pain Now Process as a form of individual training and coaching. Most of the Client’s time in this process will be spent engaged in specific exercises and activities designed to assist Client in becoming pain-free.
This is a structured 28-day process and Client agrees to participate fully. Client understands that the process is divided into three distinct phases that will begin after the prerequisites:
This is a structured 28-day process and Client agrees to participate fully. Client understands that the process is divided into three distinct phases that will begin after the prerequisites:
· Phase 1, Days 1 – 5:
The client will begin the ZPN Process on a pre-determined date, to which the Client and Client’s coach/practitioner will mutually agree. During this time and using the provided Zero Pain Now Workbook as a guide, Client will independently complete a series of exercises. Each day Client will send a short check-in note to the email address provided, confirming that the Client has completed the daily exercises.
· Phase 2, Day 6:
On this day, the Client will have a live session with his/her ZPN practitioner. Client understands that this session may last between 1 – 3 hours, depending on the Client’s individual situation, and the Client agrees to make available as much time as may be needed to complete the session. Client understands that during this time Client will engage in both a training session and an intensive guided exercise, and that Client will be asked periodically to self-report on the results Client is experiencing. Client agrees to do all of this to the best and fullest of the Client’s ability.
· Phase 3, Days 7 – 28:
During this final phase of the Zero Pain Now Process, Client understands that Client will once again independently complete a series of exercises, designed to support the Client in becoming pain-free. Client agrees to do these daily exercises to the best of his/her ability, and that each day Client will send a check-in note to his/her practitioner, to confirm that Client has completed the exercises. Client understands that his/her ZPN Practitioner will be monitoring Client’s progress throughout this period, and will be available to answer questions or address specific concerns for Client as needed.
Client understands and agrees that Client may not experience any specific desired results if the Client does not complete all structured activities as required.
Client understands and agrees that Client may not experience any specific desired results if the Client does not complete all structured activities as required.
II.DISCLOSURE AGREEMENT.
Client understands that Zero Pain Now may be considered alternative or complementary health care under the laws of a number of states.
Client understands and acknowledges that Client’s ZPN Practitioner is a legal Complementary Provider, and not a licensed Medical Doctor, Psychologist, Psychiatrist, health care professional, M.F.T. or M.S.W. The client also acknowledges that the services the Client receives are not licensed in this state, nor are they regulated by a governmental body. Client agrees that Client will be working with his/her practitioner in the capacity of a personal coach. Client understands that his/her Zero Pain Now practitioner has been fully trained and certified in Adam Heller’s Zero Pain Now Process and that he/she will provide only those services in which he/she has been thoroughly trained. Should Client want or need any medical attention or advice at any time during his/her participation in the Zero Pain Now Process, Client agrees that Client will seek it from a licensed medical professional.
Client understands and acknowledges that Client’s ZPN Practitioner is a legal Complementary Provider, and not a licensed Medical Doctor, Psychologist, Psychiatrist, health care professional, M.F.T. or M.S.W. The client also acknowledges that the services the Client receives are not licensed in this state, nor are they regulated by a governmental body. Client agrees that Client will be working with his/her practitioner in the capacity of a personal coach. Client understands that his/her Zero Pain Now practitioner has been fully trained and certified in Adam Heller’s Zero Pain Now Process and that he/she will provide only those services in which he/she has been thoroughly trained. Should Client want or need any medical attention or advice at any time during his/her participation in the Zero Pain Now Process, Client agrees that Client will seek it from a licensed medical professional.
Client understands and agrees that nothing that happens during the ZPN Process is mental health counselling or therapy, and it should not be construed as such. Further, the Client understands and agrees that it is not a substitute for the advice of a licensed mental health professional. Should Client at any time during his/her participation in the Zero Pain Now Process need mental health counselling or advice, Client agrees that Client will seek it from a licensed mental health professional.
III. CONFIDENTIALITY:
Client agrees to keep all information received from Zero Pain Now confidential and will not disclose it to persons outside of the Zero Pain Now. Coach/practitioner agrees to keep all client information strictly confidential and is for the use of Client’s ZPN Practitioner, or Coach Heller, LLC, only.
IV. Zero Pain Now GUARANTEE:
Adam Heller’s Zero Pain Now Process is guaranteed to which Client will receive the support and follow-up necessary to ensure Client receives the results he/she desires, as long as Client follows the below. Client understands and agrees that the Zero Pain Now guarantee works as follows:
The client must participate fully in and finish the Zero Pain Now Process, wherein Client will take part in each phase of the Process and fully complete every task or exercise assigned. Client understands and agrees that Client must go through the entire process all the way to the end.
The client must participate fully in and finish the Zero Pain Now Process, wherein Client will take part in each phase of the Process and fully complete every task or exercise assigned. Client understands and agrees that Client must go through the entire process all the way to the end.
Client understands and agrees that after completing the entire Zero Pain Now process that Client’s Zero Pain Now Practitioner agrees to work with Client at no additional charge until the Client has obtained the results Client desires.
V. My Choices, My Actions, My Responsibility:
During the Zero Pain, Now Process Client will be offered training, advice and other ways of thinking about the Client’s problem. Client understands and agrees that the results Client achieves will be due solely to changes in the Client’s own patterns of thought and behaviour. Client agrees that it is the Client’s responsibility to fully communicate his/her questions, concerns and results to Client’s Zero Pain Now Practitioner. Client understands and agrees that if Client does not communicate fully and openly with Client’s Zero Pain Now Practitioner, he/she will be unable to address and help resolve any questions or concerns Client may have. Client understands and agrees that the liability of Client’s Zero Pain Now Practitioner and Coach Heller, LLC is limited to the amount that the Client has paid for the Zero Pain Now Process and services.
By clicking the “I Agree” button I am agreeing to everything stated in this disclosure.
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