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I acknowledge that my participation in a review of my salivary hormone test report in a health coaching appointment is expressly conditioned on my agreement to each of the terms of this document. I acknowledge and agree as follows:

  1. The Salivary Hormone Test Results Review Consultation will include:

    1. Review of results by the Health Coach prior to the Health Coaching Session

    2. Discussion of results with me, the customer.

    3. Discussion of the information reported in the customer survey in light of the results

    4. Exploration of possible options for adjusting hormone cream use

  2. The Salivary Hormone Test Results Review Consultation will expressly not include:

    1. Any medical or nutritional recommendations related to the results

    2. Any medical diagnosis

    3. The writing of any specific prescriptions

  3. I have been advised by Parlor Games to consult with a physician about my Salivary Hormone Test Results.

    1. Health Coaching services are not offered as a substitute for medical care and are not intended to diagnose, treat or cure any medical conditions.

    2. Your Health Coach is not acting as a medical professional.

    3. You are fully responsible for your own well-being during the coaching sessions and understand that you are fully responsible for any choices and decisions you make following the session.

  4. Privacy.

    1. Your Health Coach will see your lab notes and results. Other Health Coaches and their supervising physician may also see this if needed to provide guidance to your Health Coach. This will always be done in a confidential way respecting your privacy.

    2. Be aware that while Health Coaches are in private spaces, if you are not in a private space (i.e., if you are in a cafe, or family members are around) we cannot guarantee confidentiality.

    3. You may take as many notes as you like as the Coaching Consultation will not be recorded to comply with HIPAA requirements.

  5. You are fully responsible for your own well-being during the coaching sessions and understand that you are fully responsible for any choices and decisions you make following the session

  6. I, on behalf of myself , do hereby fully release and discharge Parlor Games and its agents and employees from any and all liability, claims, and causes of action from injuries or illness (including death), damages or loss which I may have or which may accrue to me on account of participation in the Salivary Hormone Test Results Review Consultation. This is a complete and irrevocable release and waiver of liability. Specifically, and without limitation, I, on behalf of myself, hereby release the Released Parties from any liability, claim, or cause of action arising out of the Released Parties’ negligence. I, on behalf of myself, covenant not to sue the Released Parties for any alleged liabilities, claims, or causes of action released hereunder.

  7. I further agree to indemnify and hold harmless and defend the Released Parties from any and all claims resulting from injuries or illness (including death), damages, or loss, including, but not limited to attorneys’ fees, sustained by me arising out of, connected with, or in any way associated with my participation in wellness activities.

  8. Health Coaches are independent contractors and are not employees of Parlor Games.

  9. I am 18 years old or older.

  10. This document is binding upon me and my heirs, children, wards, personal representatives and anyone else entitled to act on my behalf.

Heather Pavlinsky MSN, CRNP, FNP-BC

Board Certified Aesthetic Injector - AAOPM

Board Certified in Medical Weight Loss - AAOPM

Holistic Practitioner, Wellness Coach

Migraine Specialist, Certified Functional Medicine Provider

Hormone Replacement Practitioner, Wound Care Practitioner, Primary Care Provider

Owner of Innovative Fitness Center & Innovative Beauty Salon

Medical Director: Dr Aldino Pierotti MD, Ower of Innovative Med Spa

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