Patient Advocate Agreement

WHEREAS, Advocate owns and operates a Limited Liability Corporation in Orient OH, and wishes to provide certain Patient Advocacy services, as defined below; and

WHEREAS, Client wishes to receive such Patient Advocacy services;

NOW THEREFORE, in consideration of the mutual promises contained herein, the parties agree to the following terms and conditions of the Agreement.

1. RELATIONSHIP:  Advocate and Client agree to follow and be governed by the conditions of this Agreement. Advocate and its Representatives shall be deemed independent contractors to the Client, and nothing contained herein shall be construed to create the relationship of employer and employee, including, but not limited to, pension plan, withholding of federal and state income taxes, FICA, Worker’s Compensation, and other insurances.  Advocate may practice for others during the period of this agreement when not performing work for the Client, and in addition may hire employees and/or independent contractors to serve as Patient Advocates (“Agents”) to perform some or all work that the primary Patient Advocate typically would perform under this contract.

• DUTIES AND RESPONSIBILITIES:  Advocate and its Agents at no time will interfere with the physician/patient relationship, but will be responsible for:
• To advocate within the health care team in the interests of the Client and caregivers.
• To provide the Client/caregivers with relevant verbal and written educational materials.
• To inform the Client/caregivers of the options and choices that may be relevant RE: disease prevention and management.
• To facilitate the selection of health care team members to execute the plan of care decided upon by the patient/caregivers and the physician(s)
• In order to fulfill these responsibilities, Client authorizes Advocate to have access to Client’s medical and billing records during the term of the Agreement. (See attached release form: Authorization of Representation and Disclosure of Information and Documents.)

• EXCLUSIONS:  Advocate and its associated Patient Advocate Agent(s) will not provide the following:
• Medical diagnosis, prescribing or treatments
• Hands–on care
• Psychiatric care or counseling
• Medical Financial or bill payment counseling
• Routine transportation services

• PAYMENT AND BILLING: 
• Initial Retainer. If client would like to retain services, then client will pay an initial retainer of Three Hundred Dollars ($300.00). This retainer shall be applied against your invoices for services rendered under this Agreement.
• Service Fee Structure. Compensation for services rendered under this Agreement will be based on the service package selected by the Client. Each package includes specific services and associated fees, which will be outlined in a separate Service Package Selection Form and incorporated into this Agreement by reference. The Client acknowledges and agrees to pay the fees corresponding to the chosen package.

• Billing Cycle. Client may expect billing monthly, and payment is due upon receipt of the invoice. Failure to pay billed accrued charges within 45 days of the receipt of the bill will constitute a material breach of this Agreement.  Client is solely responsible to personally pay all invoices for services rendered under this Agreement.  Client acknowledges that the services rendered under this Agreement will not be filed or billed through any insurance company or benefits policy.

• Expenses. Advocate will not charge for normal business expenses such as copies or local travel.   Advocate may charge for long-distance phone calls to international numbers, conference calls, travel over 25 miles one-way, overnight lodging and expenses, etc. Such expenses shall be itemized and added to Client’s bill.

• AGENTS:  Advocate may appoint Agent(s) to assist Advocate in the performance of their duties and obligations required pursuant to this Agreement.  Any agreement entered into between Advocate and an Agent shall:  (a) require Agent to fully comply with all Advocate policies and procedures, including requirements to maintain appropriate licenses for services to be provided; (b) not contain terms which conflict with the terms of this Agreement or grant an Agent authority to perform duties which Advocate is not authorized to perform; and (c) state that an Agent is a consultant working with the Client under the supervision of the Advocate.  Client shall have full responsibility to pay any compensation to Agent(s). Unlicensed personnel hired by Client do not have a legal relationship with Advocate and Advocate does not assume any liability for their actions or actions taken by their staffing organization.

• NO GUARANTY OR WARRANTY:  Advocate and its Agent(s) make no guarantee or warranty on the services rendered under this Agreement or on the outcome(s) of the patient.

• PROFESSIONAL LIABILITY INSURANCE:  Advocate and its Agents shall carry for the length of this contract professional liability insurance.

• WAIVER: No modification of this Agreement shall be valid, and no waiver of any of the provisions hereto shall be valid, unless made in writing, and signed by Advocate and Client.

• CONTROLLED SUBSTANCES: Should the Client engage in activities utilizing controlled substances against the express recommendations of his/her medical providers during the period of service contracted between the Advocate and the Client, this Agreement shall be terminated according to the provisions expressed in Section 11 of this Agreement.

1. DISPUTE RESOLUTION:  Any controversy or claim arising out of or relating to the terms or effect of this Agreement or the perceived breach thereof, which cannot first be resolved with good faith negotiations, shall be settled by arbitration with the assistance of a third party neutral. Fees and costs for arbitration will be equally borne by both Advocate and Client. 

1. TERMINATION:  This Agreement may be terminated by mutual agreement of the parties or by either party by giving five (5) business days written notice to the other by certified mail addressed to the address of the other.

GOVERNING LAW: This Patient Advocates Agreement, when duly executed by the parties hereto, shall be construed in accordance with the laws of the state of Arizona.  It shall supersede all previous contracts, agreements, and understandings between the parties hereto.

Health & Wellness Coaching Agreement

WHEREAS, Coach owns and operates a Limited Liability Corporation in Orient OH, and wishes to provide certain Health & Wellness Coaching services, as defined below; and

WHEREAS, Client wishes to receive such Health & Wellness Coaching services;

NOW THEREFORE, in consideration of the mutual promises contained herein, the parties agree to the following terms and conditions of the Agreement.

1. Definition of Coaching: Coaching is not therapy. Coaches are not healthcare professionals and do not provide any medical services. Coaching is not designed to treat physical or mental wellbeing, nor cure any ailments or disease. It is simply a guided conversation with recommended actions. If Client has health or wellbeing concerns, it is recommend that Client consult a health professional prior to entering a coaching relationship.  Please note that as the Client is the expert on their own life, and responsible for making all decisions related to own health and wellbeing. If Client has any questions with regard to ability to participate in coaching, please reach out to a health professional prior to entering a coaching relationship.

• RELATIONSHIP:  Coach and Client agree to follow and be governed by the conditions of this Agreement. Coach and its Representatives shall be deemed independent contractors to the Client, and nothing contained herein shall be construed to create the relationship of employer and employee, including, but not limited to, pension plan, withholding of federal and state income taxes, FICA, Worker’s Compensation, and other insurances.  Coach may practice for others during the period of this agreement when not performing work for the Client, and in addition may hire employees and/or independent contractors to serve as Coaches (“Agents”) to perform some or all work that the primary Coach typically would perform under this contract.

• DUTIES AND RESPONSIBILITIES:  Coach and its Agents at no time will interfere with the physician/patient relationship, but will be responsible for:
• To coach within the health limits in the interests of the Client.
• Clients always have the right to either accept, decline, or counter any request the Coach may make. Client and Coach will continually work together to strengthen the relationship so that it supports growth. Even though there may be a personal friendship, Coach is not a “friend” to listen to complaints, but someone who will hold Client higher than that which the Client may be accustomed. Coach will challenge Client to look beyond their “comfort zone” while providing a safe environment for to explore unfamiliar areas of Client’s life, career and being. Coach will work with Client to realize who they have to be and create a path for what they have to do to live the desired life.
• To provide the Client with relevant verbal and written educational materials.
• To inform the Client of the options and choices that may be relevant RE: movement, diet, selfcare, disease prevention and management.
• To facilitate the selection of self care to execute the plan decided upon by the Client
• In order to fulfill these responsibilities, Client will
• Be prepared and on time for every session.  Coaching sessions are designed to help Client get to the desired lifestyle .
• Feedback is encouraged.  Client will notify Coach know how the process is working and what is not working.
• Be completely truthful with Coach and with yourself.
• Be willing to stretch beyond your comfort zone.
• Client will take responsibility for choices and decisions made that arise from or are related to the coaching sessions.

• EXCLUSIONS:  Coach and its associated Coach Agent(s) will not provide the following:
• Medical diagnosis, prescribing or treatments
• Hands–on care
• Psychiatric care or counseling
• Medical Financial or bill payment counseling
• Routine transportation services

• IN-BETWEEN SESSIONS POLICY:  The policy for connecting in-between sessions is as follows:
• Communication, accountability, sharing successes and roadblocks can all be easily handled via e-mail. This can be a great tool to keep diving deeper and doing self-coaching work. If Client needs to call Coach, please do so at regular business hours. Client may consider purchasing a notebook to record any notes and thoughts afterour sessions to help “lock in” learning and questions for next session.
• Any additional assistance in-between coaching sessions, will require a review in coaching package purchased.

• PAYMENT AND BILLING: 
• Initial Retainer. If client would like to retain services, then client will pay an initial retainer of Three Hundred Dollars ($300.00). This retainer shall be applied against your invoices for services rendered under this Agreement.
• Service Fee Structure. Compensation for services rendered under this Agreement will be based on the service package selected by the Client. Each package includes specific services and associated fees, which will be outlined in a separate Service Package Selection Form and incorporated into this Agreement by reference. The Client acknowledges and agrees to pay the fees corresponding to the chosen package.

• Billing Cycle. Client may expect billing monthly, and payment is due upon receipt of the invoice. Failure to pay billed accrued charges within 45 days of the receipt of the bill will constitute a material breach of this Agreement.  Client is solely responsible to personally pay all invoices for services rendered under this Agreement.  Client acknowledges that the services rendered under this Agreement will not be filed or billed through any insurance company or benefits policy.

• Expenses. Coach will not charge for normal business expenses such as copies or local travel.   Coach may charge for long-distance phone calls to international numbers, conference calls, travel over 25 miles one-way, overnight lodging and expenses, etc. Such expenses shall be itemized and added to Client’s bill.

• AGENTS:  Coach may appoint Agent(s) to assist Coach in the performance of their duties and obligations required pursuant to this Agreement.  Any agreement entered into between Coach and an Agent shall:  (a) require Agent to fully comply with all Coach policies and procedures, including requirements to maintain appropriate licenses for services to be provided; (b) not contain terms which conflict with the terms of this Agreement or grant an Agent authority to perform duties which Coach is not authorized to perform; and (c) state that an Agent is a consultant working with the Client under the supervision of the Coach.  Client shall have full responsibility to pay any compensation to Agent(s). Unlicensed personnel hired by Client do not have a legal relationship with Coach and Coach does not assume any liability for their actions or actions taken by their staffing organization.

• NO GUARANTY OR WARRANTY:  Coach and its Agent(s) make no guarantee or warranty on the services rendered under this Agreement or on the outcome(s) of the client.  Coach and Client relationship is completed appropriately and that Client will be provided with all the resources needed for the next step in the Client’s health & wellness  journey.

• RESCHEDULING AND CANCELLATIONS:  Client will contact Coach at least 48 hours in advance to reschedule or cancel a session. Cancellations or reschedules not made 48 hours or more before scheduled session will require that session be paid in full.

• PROFESSIONAL LIABILITY INSURANCE:  Coach and its Agents shall carry for the length of this contract professional liability insurance.

1. WAIVER: Client releases, waives, acquits, holds harmless, and discharges Coach and agents, successors, assigns, personal reps, executors, heirs, and complies (collectively called, “Coach”) from all liabilities and every claim, suit, action, demand, or right to compensation for damages Client may claim to have or that Client may have arising out of actions, omissions, or commissions taken by Client or by Coach as a result of the advice given by Coach or otherwise resulting from the coaching relationships contemplated hereunder. Client further declares and represents that no promise, inducement or agreement not herein expressed has been made to Client to enter into this Agreement. The Agreement and release made pursuant to this paragraph shall bind Client’s heirs, executors, personal repos, successors, assigns, and agents.

• Client agrees that Coach may provide Client with other sources of information, including but not limited to links to websites, printed materials, or audio, and Client understands that Coach makes no warranties as to accuracy nor reliability of such information, including their privacy policies. Client will not hold Coach liable for any incident or consequential damages resulting from use or affiliation with such materials.
• Client acknowledges that Coach is not a licensed healthcare provider and does not engage in patient diagnosis or the practice of medicine.  Similarly, Coach is not a counselor or psychotherapist and does not purport to offer mental health care advice.
• Information and coaching provided by Coach does not constitute legal, financial, tax, medical or other types of evaluation, advice or representation and is not intended to substitute such evaluation, advice or representation.
• Client agrees to independently assess any decisions, actions or inactions resulting from or relating to the coaching experience based on medical, psychological, psychiatric, legal, financial, tax, or other advice as applicable.
• Client understands that results are not guaranteed and it is the sole responsibility of the Client to make their own opinions, choices and decisions as well as determine appropriateness and effectiveness of services rendered as well as competency of the Coach.

1. CONFIDENTIALITY CLAUSE: The coaching relationship, and all matters discussed within, are confidential. Coach may opt to record coaching sessions, so the recording can be reviewed in the future. These recordings are not for any other purpose, are never shared with an outside party unless given explicit permission, and are kept confidential.

Coach will suspend this confidentiality agreement in the following cases:

1. Client reports imminent suicidal or homicidal ideation.
2. Client reports abuse or neglect of a child, dependent or older adult.
3. Coach is ordered by court of law to do so.
4. Client reports anything that causes the coach concern for the health and safety of client or others.

1. CONTROLLED SUBSTANCES: Should the Client engage in activities utilizing controlled substances against the express recommendations of his/her medical providers during the period of service contracted between the Coach and the Client, this Agreement shall be terminated according to the provisions expressed in Section 11 of this Agreement.

1. DISPUTE RESOLUTION:  Any controversy or claim arising out of or relating to the terms or effect of this Agreement or the perceived breach thereof, which cannot first be resolved with good faith negotiations, shall be settled by arbitration with the assistance of a third party neutral. Fees and costs for arbitration will be equally borne by both Coach and Client. 

1. TERMINATION:  This Agreement may be terminated by mutual agreement of the parties or by either party by giving five (5) business days written notice to the other by certified mail addressed to the address of the other.

1. GOVERNING LAW: This Health & Wellness Coaching Agreement, when duly executed by the parties hereto, shall be construed in accordance with the laws of the state of Arizona.  It shall supersede all previous contracts, agreements, and understandings between the parties hereto.

INFORMED CONSENT:  Client give informed consent to engage in coaching services and for Coach to assist in coaching for the aforementioned purpose(s).  Client is responsible for  their own participation in coaching and for their well-being.  Client agrees that they are using coaching services entirely at their own risk.  Coaching is provided “as is” without any warranty of any kind, express or implied.  Client warrants that any decisions, actions, or inaction they made and consequences thereof, are their own and their own risk and that Client takes full responsibility for all emotional, mental, behavioral, and physical risks.  Client agrees to hold Coach harmless from any and all liability arising from participation.