Hack your Hormones – Registration Page

Program Terms and Conditions

Hack your Hormones Group Program Consent form

This Coaching Agreement (“the Agreement”) was created to ensure that in using the services offered by me Debra Smrz and, you, the Client are both protected. By signing this Agreement, you are entering into a legally binding contract, so please read it carefully and contact us before you sign if you have any concerns.

The Parties

This AGREEMENT is entered into as of (date as indicated below) by and between the Client (name as indicated below) and Dr. Debbie Smrz (the Coach).

WHEREAS the Client requires and wishes to utilize, and the Coach agrees to provide, the coaching services (the Services) of the Coach as outlined herein; NOW, THEREFORE, this Agreement confirms that in consideration of the following promises hereinafter expressed on the part of the Client and the part of the Coach and the fees to be paid as outlined below, the Parties hereto agree to the terms and conditions as follows:

The Hormone Hacking Group Program

The Hormone Hacking Program is a community health initiative.

⁠ It is a group program created by Dr. Debbie Smrz providing evidence-based information to support hormone health, , energy and brain health.

⁠What I/We expect from my/our clients

I/We have certain requirements for what characteristics work well for this type of facilitation and coaching. You must be:

• A patient of Dr. Debbie Smrz, living in Ontario. A 30-minute 1:1 appointment is included in the price to establish a doctor-patient relationship.

- As this is a group program, Dr. Debbie will be coaching the majority of the time and all suggestions may not apply to your personal case. You have the opportunity to get clarification from Dr. Debbie as your Naturopathic doctor via email.

• Respectful in your language and tone with all other participants in our Facebook group. Please note that we have a no tolerance policy for any form of discrimination, harassment or abuse. Any participant who fails to adhere to this policy will be asked to leave the group / course with no refund.

Fees & Payment

• Fees: The Client agrees to pay to the Coach, in consideration of the Services outlined herein, the following agreed

amounts (the Fee):

• $199.00 + applicable tax
• Fee schedule will be outlined in a separate email.
• The Client shall provide the Coach with their credit card information as security for payments being made if unable to pay online.

Coach shall be authorized to charge the Client’s credit card(s) for any unpaid charges on the dates outlined herein.

The Coach shall be entitled to make all charges at the time payments are due and not require separate

authorization for any multiple-payment plan or if the Client is in arrears to the Coach. The Client shall not make any chargebacks to the Coach’s account and/or change and/or cancel the credit card provided as security without the Coach’s prior written consent. The Client shall be responsible for any fees associated with recouping chargeback expenses or collection fees.

If payment is not received or there is a problem with the payment transaction or method, you will be notified by e-mail and have a 3-day grace period to make the payment following the due date. During this time, the Program will be put on hold and no Coaching Sessions will be held, including during the grace period. If no payment is made within the 3-day grace period, the Program will automatically terminate and you will forfeit any remaining Coaching Sessions and Program access.

The Fine Print

• Confidentiality. Any and all information shared by the Client will be held confidential by the Coach.

- As this is a group program, you have the opportunity to share information. This is at your own discretion. You are under no obligation to disclose any personal information.

This includes all discussions and any written materials. Furthermore, no information will be released to any other individual or agency without specific consent of the Client, unless specifically required by law or if there exists danger of harm to the Client or someone else. The Coach will make every effort to safeguard personal information. The Coach has the right to use case studies of the Client’s situations and or in future work but without making reference to the Client’s identity. The Client will always be contacted for notification prior to any case study or being published. The Client will not be identified by their full name.

• Refund policy: The Client SHALL NOT receive any refund for ANY AND ALL REASONS, subject to the sole and absolute discretion of the Coach for the education component of the course.
• Intellectual Property Rights: The Coach retains all ownership rights to the materials provided during your participation in the Program. The copyrighted and original materials you are provided are for your individual use only and with a single-user license. You are not authorized to share, copy, distribute, or otherwise disseminate any materials received from me electronically or otherwise without my prior written consent. All intellectual property, including the copyrighted Program materials, shall remain the sole property of the Coach, and no license to sell or distribute materials is granted or implied. You agree not to reproduce, duplicate, copy, sell, trade, resell or exploit for any commercial or personal purposes, any portion of the Program, including any of the Program materials.

• Relationship of the Parties: The Coach and any related subcontractors are not employees, partners, or members of the Client or the Client’s company or organization. The Coach has the sole right to control and direct the means, manner, and method by which the Services in this Agreement are performed. The Coach has the right to hire assistants, subcontractors, or employees to provide the Client with its Services. The Parties are individually and separately responsible for their own business operation and expenses, including securing or paying any licensing fees, taxes, registrations, or permits. The Client is not responsible for paying for any benefits, Workers Compensation, insurance, or unemployment fees to the Coach.

• Personal Responsibility and Assumption of Risk: The Coach has used care in preparing the information provided to you, but the information, Programs, and services have been made available to you as tools for your own personal use and for informational and educational purposes only. You accept full responsibility for your choices, actions, and , and expressly assume the risks of the Program for your use, or non-use, of the information provided to you. You also understand that you are expressly assuming all of the risks of the Program, whether or not such risks were created or exacerbated by the Program.
• General Disclaimer. The Coach makes no guarantee or warranty regarding the program meeting the Client’s needs. The services and all other goods and information provided by the Coach herein are provided on an “as is” basis without warranties of any kind, either express or implied. The Coach disclaims all warranties, express or implied, arising by law or otherwise, with respect the services or any other goods and information provided by, through or on behalf of the Coach under this agreement, including, without limitation, any implied warranty of merchantability, fitness for a particular purpose or noninfringement and any implied warranty arising from course of performance, course of dealing or usage of trade.

• Medical Disclaimer: The Coach is not acting in the capacity of a medical doctor or as the Client’s personal pharmacist, dietitian, psychologist or any other licensed medical or related professional outside of designated care sessions. The Coach is not providing medical care, pharmaceutical care, nutritional services and will not assess, manage or provide care for in any manner whatsoever any disease, condition, physical or mental ailment in the group setting or as part of the educational course. All information is for informational purposes only and is not intended to be used as a substitute or replacement of medical care, care and/or advice obtained from and through licensed qualified medical professionals.

• Limitation of Liability Indemnification, and Release of Claims. The Coach may not be held responsible in any way for the information that you request or receive through this Program. By signing this Agreement, you fully and completely hold harmless, indemnify and release the Coach and any employees, staff, consultants, agents, or anyone affiliated with us from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, that you ever had, now have or will have in the future against us, arising from your participation in or in any way related to the Program, even if we were aware in advance of the possibility of any such claim.

 

General Information

Here’s some additional information you need to know before we get started!

• Jurisdiction. This Agreement will be governed by and construed in accordance with the laws of Canada and the province of Ontario as applicable.
• Severability. If any provision of this Agreement is invalid or unenforceable, the other provisions in the Agreement will remain in full force and effect.
• Modification. Any modification of this Agreement or additional obligation assumed by any Party in connection with this Agreement shall be binding only if evidenced in writing signed by both Parties.
• Assignment. Neither this Agreement nor any other rights or obligations under this Agreement shall be assigned or otherwise transferred.
• Dispute Resolution. Client and Coach will work to work out any differences through a phone conversation or via email. However, should a dispute ever arise between us, we agree now that we will subject to final and binding arbitration before a single arbitrator, selected jointly .
• Non-disparagement. Client shall not make any false, disparaging, or derogatory statement in public or private regarding the Coach, its employees, or agents. The Coach shall not make any false, disparaging, or derogatory statements in public or private regarding the Client.
• Entire Agreement. This Agreement constitutes the entire Agreement between the parties and replaces any prior written or oral agreements.
• Waiver of Breach. The waiver by me/us of any breach by you of any provision of this Agreement will not be taken to be a waiver of any further breaches by you.
• Notice. For the purpose of this Agreement, e-mail will suffice for written notice when required as set out above.
• Headings. The headings used in this Agreement are for stylistic purposes only and none of the content in the headings are intended to be legally binding.
• Counterparts. This Agreement may be executed electronically and in counterparts, each of which will be deemed an original and all of which taken together shall constitute one and the same agreement.

Consent

The Client, volunteers to be coached/to take part in the Program. The Client understands that Debbie Smrz are providing the services of a coach and not a doctor during the group calls. The Client understands that they must speak with their own health care professionals before implementing anything new, whenever necessary.

 

Privacy and Sharing of Information

* I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial care. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.

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Collection of Information

We are committed to collecting, using and disclosing your information responsibility and do so for the following purposes:

* To assess your health concerns, provide health care and advise you of care options

* To establish and maintain contact with you, remind you of upcoming appointments, and allow us to efficiently follow-up for care

* To complete claims for insurance purposes, and invoice for goods and services

* To comply with all regulatory and legal requirements including court orders, statutory requirements to advise authorities of child abuse, reportable diseases, and individuals who may be an imminent threat to harm themselves or others.

* I understand that I may look at my medical record anytime and can request a copy of it by paying a reasonable fee.

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Email communication

* I understand that I may have the option of communicating with the naturopathic doctor via email. I understand that my naturopathic doctor cannot provide medical advice, make care recommendations or address health concerns via email, and that these must be addressed by making an appointment. Email may be used to clarify existing care protocols should you have any questions.

* I understand the risks associated with communicating by email and understand that in-person verbal communication is the most secure method of communication.

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Health Risks

*There are slight health risks associated with naturopathic care such as an allergic reaction to or side effects from a supplement and/or herb. I understand that my naturopathic doctor will inform me of the risks associated with my specific care plan.

* I will give my naturopathic doctor full and accurate information about my health, medications and supplements, illnesses and allergies. I will notify my naturopathic doctor if I am pregnant, suspect I am pregnant or am breast-feeding.

* I understand that I must let me practitioner know if I am carrying, or believe to have any infectious agents/illnesses, including but not limited to HIV, tuberculosis and hepatitis. In some cases where cross infection is high, my practitioner may withhold care.

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Informed Consent

* I give consent to Dr. Debbie Smrz to offer me medical advice, which I may or may not follow.

As a patient, you receive information about your diagnosis, care, available reasonable alternatives, associated costs, expected benefits, risks, any side effects, and in each case the consequences of not having the care.

* I understand that results are not guaranteed. I understand that not all risks and complications can be foreseen and I will advise my naturopathic doctor immediately if I experience any adverse reactions.

* I understand that in some cases, my symptoms may temporarily worsen before they begin to ease.

* I understand that the naturopathic doctor has not suggested or recommended me to refrain from following or seeking the advice of another health care provider.

* I understand that I have the right to withdraw consent at any time and for any reason.

 

Independent Legal Advice

The Client acknowledges and agrees:

1. that the Client has fully read and understood this Agreement;
2. that the Client has had the opportunity to obtain legal advice about the Agreement; and
3. that the Client accepts the terms and conditions set out in this Agreement, including but not limited to, those which

deal with the waiver of all claims against the Coach, and obligations to pay the Coach.

I acknowledge and agree that I have read, fully understand and agree to be bound by each and every clause in this Agreement and have been given the full opportunity to discuss all implications, legal or otherwise.