By indicating below, you understand that Nina Chanpreet Kaur of Whole Brain Whole Body (“Practitioner”) and their agents and designees will be providing care to you and any child(ren) or spouse(s) (“Client” or “Clients”) listed above relevant to any Lactation & Infant Feeding services booked (“Services”), detailed in the Scope of Services below. Collectively, the Practitioner and Client or Clients will be referred to as “Parties”. This Agreement sets forth the entire understanding of the Parties and supersedes all prior agreements between the Parties. The Parties agree as follows:
Services are detailed below and may be performed by 1 or more Practitioners that may hold the credentials of the following:
• International Board Certified Lactation Consultant (IBCLC)
• Certified Lactation Consultant (CLC) or Certified Breastfeeding Counselor (CBC)
• Certified Holistic Health Practitioner (CHHP)
Consent for Care:
The Practitioner will take a thorough history and will observe, assess and evaluate the Client & the Client’s concerns. The Practitioner will provide information to help the Client reach their goals. The Client understands no outcome can be guaranteed.
During a lactation consultation, the Practitioner will examine Client and Client’s breast/chest both visually and/or manually. Practitioner will also examine Client including baby/babies both visually and/or manually (including an oral exam with a gloved finger). Practitioner will observe Client while feeding, make clinical observations, provide information on techniques and breastfeeding equipment, and make recommendations towards helping Client reach breastfeeding/feeding goals.
If another person of the Client’s choosing is present during a consultation, the Practitioner cannot guarantee the privacy of Client’s healthcare information or confidentiality. The Client acknowledges that the Practitioner is not responsible for any breach of confidentiality made in such a situation.
Client shall provide the Practitioner with the names and contact information for other relevant healthcare providers. The Client understands that, whether they provide this information, the Practitioner may communicate with their relevant healthcare providers. By agreeing to the Services, the Client is authorizing the Practitioner to do so without exception. The policy for communication with health care providers is to send and receive faxes unless otherwise requested by the Client or health care provider.
Further, the Client understands that under no circumstances does that Practitioner diagnose diseases, disorders or conditions or provide medical treatment, therapy or advice. If the Practitioner brings to the Client’s attention information about possible root causes, disorders or conditions, the Client should seek appropriate medical advice from their licensed medical professional upon being informed of this. The Client acknowledges that such information is not a diagnosis or conclusion about the state of their medical status and that they are to promptly consult a licensed medical professional about any possible medical concerns.
Client Responsibilities:
The Client’s full participation, cooperation and diligence constitutes good standing and is a required and integral part of receiving Services from the Practitioner. The following responsibilities pertain to all clients:
- Providing honest and accurate information pertaining to medical status, health & well-being. Overall, it is the Client’s responsibility to notify the Practitioner about any changes or updates that could affect their work together. This information may include Protected Health Information as defined by applicable law, as set forth in the Notice of Privacy Practices. In providing services to the Client, the Practitioner, is relying upon the thoroughness, truth, accuracy, and completeness of all information the Client has provided.
- Ensuring a safe environment for in-home sessions (clean, no active construction, structurally sound, free from unlawful activity, etc.).
- Understanding that any action undertaken by Client is undertaken of their own free will, and they accept ultimate responsibility for their health and that of their family’s. Client acknowledges that their health is in their own hands, and they may not expect to see results without following through with recommendations and care plan the Practitioner provides. Client understands they should always do their due diligence which includes their own research and consulting their own licensed medical professional under all circumstances including but not limited to:
• for any medical interpretation of test results/reports
• on any matter relating to Client’s medical status
• before making any changes to diet or lifestyle
• before taking any supplements
• before beginning any therapy or method
• before using a product and reviewing all package/label details - Understanding that the Practitioner reserves the right to determine the following:
• which cases fall outside their scope of practice, in which case an appropriate referral will be recommended.
• discretion with regard to clinical approach for the care of the Client given ethical guidelines pursuant to the Practitioner’s scope of Service. This includes whether the Client is an individual, dyad or family group in the service of the best care of the Client. - Communicating directly with the Practitioner about any concerns or questions pertinent to the care received.
Communication Policy:
The Practitioner makes every effort to abide by HIPAA regulations and provide secure means of online communication including using secure passwords, firewall software & a VPN service. Please review the HIPAA Privacy Practice Notice for more information on HIPAA compliance.
All communications regarding care from the Practitioner will be sent via email, including a care plan which will be sent out within 24-48 hours following the Client’s session. Additional notifications for appointments, scheduling and follow up may be sent via text.
Due to the nature of online communication, no data transmission over the Internet or other network can be guaranteed to be 100% secure. As a result, The Client understands that the Practitioner cannot and does not guarantee the security of any information transmitted online. As such, the Client accepts these risks without exception and agrees to hold the Practitioner harmless from any and all claims and liabilities arising from or related to communication via email or text messaging.
Further, the Client understands that if they include any third party on an email or text with the Practitioner, they are granting permission for the Practitioner to communicate their health information and that of their baby or babies with that third party. The Practitioner will not initiate inclusion of any third party on an email or text unless asked to do so by the Client or for any urgent reason that necessitates that communication to be determined at the discretion of the Practitioner. The Client acknowledges that the Practitioner is not responsible for any breach of confidentiality made by any person added by the Client as a third party to text or email.
The Client understands that it is their choice to have someone else they choose to be present during the visit, and that anyone who sits in on the visit will have access to their healthcare information and their confidentiality may not be guaranteed. The Client acknowledges that the Practitioner is not responsible for any breach of confidentiality made by any person they invite to be present during a visit.
Liability Release:
The Practitioner is in no way liable for the Client’s health or safety. In consideration of the Client’s participation in the Services, the Client hereby accepts all risks to their health, including injury or death that may result from such participation and the Client hereby releases the Practitioner on their behalf and on behalf of any of their personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to the Client, including death, that may result from or occur as a result of their participation in the Services, whether caused by negligence or otherwise. To the maximum extent permitted by law, this includes:
- Any and all liability in contract, tort (including negligence), breach of statutory duty or otherwise for any direct, indirect, special, incidental, or consequential costs, losses, claims, damages, expenses or proceedings (including but not limited to loss of profits and wasted time) incurred or suffered by me arising directly or indirectly out of or in connection with our services, including but not limited to any loss, damage or expense arising from any defect, error, imperfection, fault, mistake or inaccuracy with the information or advice Practitioner provides.
- Any and all liability for injury or loss arising out of the use of, or reliance on, the laboratory results and/or the dietary, supplement and lifestyle suggestions Practitioner may provide.
- Any and all liability for injury or loss arising from any product I may choose to use.
- Any and all liability for any failure to identify any medical condition or disease. I understand and agree that this is not the purpose of the services.
- This is a comprehensive limitation of liability that applies to all damages of any kind, including (without limitation) compensatory, direct, indirect or consequential damages, loss of data, income or profit, loss of or damage to property and claims of third parties.
Governing Law:
In the event of a dispute arising under this agreement, the Parties are encouraged to seek an early mediated resolution. Should there not be a mediated resolution, the Parties agree that their sole remedy for any dispute under this Agreement shall be final and binding arbitration in the State of New Jersey. This contract shall be construed under and in accordance with the laws of the State of New York and shall be governed in accordance with and subject to the laws of the State of New York, without regard to Conflict of Law principles.
Termination & Arbitration:
Either the Client or the Practitioner may terminate this agreement at any time, without the need for advanced notice. Any outstanding payments are still due by the Client irrespective of any possible future termination and the billing & scheduling policy will still be in effect. Should termination occur for any reason, the Client understands that s/he and his/her family will no longer be provided any services. Further, the Client waives the right to pursue any legal claim against the Practitioner and its agents and designees. The sole method of resolving any dispute related to this Service Agreement will be arbitration.
Severability:
If one or more of the provisions in the Agreement is found invalid, illegal or unenforceable in any respect, the validity and enforceability of the remaining provisions shall not be affected. Any such provisions will be revised as required to make them enforceable.
Waiver:
No term or provision of this Agreement may be waived or modified unless such waiver or modification is in writing and signed by the party against whom such waiver or modification is sought to be enforced.
Entire Agreement:
This agreement sets forth the entire understanding of the Parties and supersedes all prior agreements between the Parties. Both Parties acknowledge that any changes to this agreement must be made in writing, signed by all Parties.