The Refresh: Policies and Terms of Service
OUR HEALTH PROVIDER:
Beth Auguste MS RDN CSOWM WFS is a registered dietitian nutritionist, board certified specialist in obesity and weight management and women’s fitness specialist.
Pennsylvania Nutrition License DN006499
(267) 281-3363 BE WELL WITH BETH LLC 1901 S. 9TH STREET, BOK BUILDING SUITE 508, PHILADELPHIA, PA 19148 (267) 281-3363
As members in good standing with each of her associations. Beth Auguste abides by their codes of ethics and is accountable to each of their governing bodies for ethical and professional standards. You may ask to see these codes at any time. Should you feel that an ethical violation has occurred through which you have experienced some measure of harm, you have a right to register a complaint with the Ethics Committee of the American Dietetic Association, Commission on Dietetic Registration or National Academy of Sports Medicine.
Your file contains any correspondence we have exchanged during the program that is relevant to your treatment plan as well as your contact information. Your file also may contain any brief session notes from private sessions we have together, if applicable. This enables us to provide you with the best care possible. Files are kept in a HIPAA compliant electronic medical record system, Practice Better.
You are welcome to review your file at any time. No records will be shared with any other parties without your signed permission on a ‘Consent for Release & Exchange of Information’ form. It is your choice whether information is released and you are not required to sign any consent if you are not comfortable with it.
Everything that is said via email or in the context of the conversations between service provider and client is kept confidential. There may be times consultations may be made with another therapist or health professional. This is similar to a physician getting a “second opinion” and can be very helpful in therapeutic treatment. If consultation does occur, identifying information such as your surname will not be disclosed.
Regarding group coaching sessions. You have the right to confidentiality and privacy by the group leaders
and other group members. Confidentiality within the group setting is a shared responsibility of all
members and leaders. While group leaders may not disclose any client communications or
information except as provided by law, group members’ communications are not protected. As
such, confidentiality within the group setting is often based on mutual trust and respect.
There are a few exceptions to confidentiality which you should be aware of:
1. When the client gives written permission (a signed release form) to have information from the counselling sessions communicated to another person.
2. When the client is at risk to hurt themselves or others, as when there is danger of suicide or assault.
3. When there is reason to believe that a child has, is, or may be in danger of sexual or physical abuse or
a. When domestic violence is reported and there is a child or children in the home
b. When a client discloses that he/she was abused in childhood and there is a possibility that the abuser may be a danger to other children now. In these situations I am legally bound to report
to Family & Children’s Services
4. When mandated by a court order.
At times it may be suggested that I make contact with other professionals or family members in order to obtain information that will be helpful in your treatment. A signed ‘Consent for Release & Exchange of Information’ form is required and you have the right to refuse your signature. Should information be requested by anyone outside of my office, you will be notified.
If it is not an emergency situation, then signed consent is required and the person/agency requesting the information will not receive it, or be informed you are attending sessions, until the proper signature is received from you. If it is an emergency situation you will be informed via telephone, email or in person, as soon as possible. An emergency situation would be an urgent police, medical or child protection situation. Should there be proceedings before the courts and your records are subpoenaed you will be notified as soon as possible.
As a client you have the right:
1. To ask questions at any point in time regarding therapeutic or program procedures.
2. To terminate the program at any time; you may ask me for a list of possible referral sources. (Please see our program refund policy)
3. To be informed of any information, decisions and actions that will affect you.
4. To ask about alternative procedures available for meeting your goals.
5. To review all documentation in your client file.
You have 7 days from the date of purchase to receive a refund for the full amount of the program with credit card processing fees subtracted.
PROGRAM LENGTH AND FEES
Fees for this program are due in full or in part according to our payment plan. This includes 6 month access to our course content and group coaching calls. Payment can be made via credit card only.
Interns may observe and take notes on weekly call sessions.
INFORMED CONSENT FOR NUTRITION SERVICES
I am employing the group coaching services of Be Well with Beth 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 the clinicians at Be Well with Beth are Dietitians/Nutritionists — not physicians — and they do not dispense medical advice nor prescribe treatment. Rather, they provide education to enhance my knowledge of health as it relates to foods, dietary supplements, and behaviors associated with eating. While nutritional 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 or testing provided in counseling is not intended for the diagnosis of disease. Rather, these assessment tests are intended as a guide to developing an appropriate health-supportive program for me, and to monitor my progress in achieving my goals. I agree to hold Be Well with Beth harmless for claims or damages in connection with our work together. This is a contract between myself and Be Well with Beth, and I understand that it is also a release of potential liability. I hereby release Be Well with Beth from any claims that may arise in the future as the result of injury or loss I suffer as the result of negligence by Be Well with Beth in the provision of services to me.
I understand I have the right to stop following the program at any time, and may ask for a list of referral sources. I understand that it is usually best for Service Providers and clients to make joint decisions about termination of treatment.
INFORMED CONSENT FOR HEALTH AND FITNESS COACHING
I have enrolled in a program offered through Be Well with Beth, Beth Auguste MS RD CSOWM. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation is purely voluntary and is in no way mandated.. In consideration of my participation in this program, I hereby release Be Well with Beth from any claims, demands, and causes of action as a result of my voluntary participation and enrollment. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Be Well with Beth from any liability now or in the future for conditions that I may obtain. I hereby release Be Well with Beth from any claims that may arise in the future as the result of injury or loss I suffer as the result of negligence by Be Well with Beth in the provision of services to me. These conditions may include, but are not limited to, heart attacks, strokes, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, injuries to knees or other joints of the body, injuries to back or neck, injuries to a foot, heat prostration, or any other illness or soreness that I may incur, including death.
I agree to INDEMNIFY AND HOLD HARMLESS Be Well with Beth, which includes any increase in liability insurance premiums incurred by Be Well with Beth as a result of any claim made of loss suffered by me, such indemnity to be of and from any nature whatever arising out of or in any way relating to my use of the facility, equipment, classes or programs regardless of whether I followed safety policies or received or training from Be Well with Beth.
I UNDERSTAND THAT I AM FULLY RESPONSIBLE FOR THE ACTIONS OF MYSELF AND ASSUME ALL RISKS OF ILLNESS, INJURY, AND LOSS TO MYSELF.
Be Well with Beth periodically takes photographs and/or video for advertising purposes including but not limited to print ads and website. I hereby grant Be Well with Beth permission to use my likeness (or my minor child) in a photograph in any and all of its publications,
including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Be Well with Beth and will not be returned. I hereby irrevocably authorize Be Well with Beth to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Be Well with Beth programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my (or my minor child’s) likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Be Well with Beth from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 18 years of age and am competent to contract in my own name and on behalf of my minor child. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
My payment indicates that I am giving my consent for Beth Auguste to counsel, coach & support me in The Refresh Program.
BY CLICKING BELOW AND MAKING THIS PURCHASE I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE TERMS CONTAINED IN THIS DOCUMENT.