Enrollment

Your Information

Let's start with your basic information.

First Name *

Last Name *

Email Address *

This is the email we'll use for program access and communication.

Phone Number *

Street Address *

City *

State *

ZIP Code *

Country *

I agree to receive program-related emails and texts (access, scheduling, updates).

Health Intake

Help us understand your journey so we can better support you. Your answers are used to personalize your experience in the program and are kept private within our team.

Year of Birth *

Where are you in your menopause journey? *

How would you rate the overall severity of your symptoms? *

Are you currently using any treatments or supplements for menopause symptoms? *

What are your primary health goals for this program? *

Do you have any medical conditions we should be aware of? *

Current Medications *

Do you have any allergies? *

How did you hear about us? *

Is there anything else you'd like us to know?

Liability Waiver

Please review and acknowledge the liability waiver.

Assumption of Risk and Release of Liability

I hereby acknowledge and agree:

The purpose of menopause counseling is to improve the overall health, vitality and well-being of the body through behavior change, education, and the use of natural foods and non-medicinal nutritional supplements. The Integrative Nutrition Health and Menopause Coach does not diagnose diseases, disorders or conditions.
The Integrative Nutrition Health and Menopause Coach is not a licensed Dietitian, Naturopathic Doctor or Medical Physician.
As part of the Menopause Counseling Services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle, and diet. This information is collected to enable the Coach to: (i) assess my knowledge of nutrition, (ii) educate me about the benefits of sound lifestyle practices and (iii) recommend dietary, sleep, and exercise, and behavior changes to improve my general health, vitality, and overall well-being. This information will be held in confidence.
If the Coach suspects the existence of disease, disorder, or condition, I will be informed of this suspicion. However, I acknowledge this is not a diagnosis and I am directed to promptly consult a licensed Physician or Naturopath.
Any recommendations I follow for changes in behavior or diet, including the use of nutritional supplements, are entirely my responsibility.
The Coach shall not be liable for any claims related to my health, safety, or physical well-being, including those claims resulting from the negligence of the Coach, arising out of my participation in these services.
In consideration of my participation, I hereby release, hold harmless, and agree not to sue the Coach for any and all liability, including claims of negligence, for any physical or mental injury or death that may result from my participation.

I have carefully read this agreement and understand that it is a full release of liability. I am choosing to participate freely and voluntarily, and I understand that by signing, I am waiving certain legal rights, including the right to sue for negligence. I acknowledge that I am responsible for my own health and well-being throughout this program.

I have read, understand, and agree to the Assumption of Risk and Release of Liability above.

Health Disclaimer

Please review and acknowledge the health coaching disclaimer.

Health Coaching Disclaimer

Please read and acknowledge the following:

Not Medical Advice: Health coaching is not intended to diagnose, treat, cure, or prevent any disease or condition. It is not a substitute for professional medical advice, diagnosis, or treatment.
Educational Purpose: The information provided during coaching sessions is for general educational purposes only and is not intended to replace professional medical consultation.
Personal Responsibility: You are solely responsible for your own health decisions and for consulting with qualified healthcare providers regarding your health.
No Guarantees: Results may vary. No specific outcomes or results are guaranteed from participating in health coaching services.
Lifestyle Recommendations: Any suggestions regarding lifestyle, nutrition, supplements, or exercise are general recommendations and should be discussed with your healthcare provider before implementation.
Emergency Situations: Health coaching is not appropriate for emergency situations. If you are experiencing a medical emergency, please call 911 or go to your nearest emergency room.
Medication Changes: Never change or stop taking any prescribed medications without first consulting with your prescribing physician.
Confidentiality: While we maintain strict confidentiality, coaching sessions are not protected by therapist-patient or doctor-patient privilege.

I understand and agree that health coaching services are educational in nature and not a substitute for medical care.

Sign Agreement

Sign to confirm your agreement to all terms.

By signing below, you confirm:

✓ All information provided is accurate and complete
✓ You have read and agree to the Liability Waiver
✓ You understand the Health Coaching Disclaimer
✓ You agree to the program terms and conditions

Type Your Full Legal Name *

Today's Date *

Draw Your Signature *

I confirm that all information I have provided is true and accurate, and I agree to all terms and conditions outlined in the previous steps.

Payment

Complete your enrollment with payment.

Thrive During the Transition

$697

Card Details *

Secure payment processed by Stripe

By completing this purchase, you understand this is a live, limited‑seat program and all enrollments are final and non‑refundable after February 23