Harbor Essentials Agreement


Essentials Program Client Agreement

Welcome! I am looking forward to working with you. Please read this information carefully.  The purpose of this Agreement is to set forth the details about working together so that we both are clear as to what each of our respective roles are and how our communication will take place so that our time will be positive, productive, and comfortable.

This Agreement is being made between Mel Hopper Koppelman of Harbor Integrative Health, LLC of The Barn, 60 Poppasquash Road, Bristol, RI 02809, USA (“Practitioner” or “me”) and     (“Client” or “you”). 

We both legally agree to the following:

Program Description.

Your Program (“Program”) includes:

  • Initial Clinical Case Review
  • Report of findings consultation
  • Two clinical follow up consultations
  • Initial 90 minute lifestyle and nutrition consultation
  • 2 60 minute lifestyle and nutrition follow up consultation
  • 1 30 minute lifestyle and nutrition follow up consultation
  • A Youtrients DNA Genetic analysis
  • 1 60 minute consultation with a Youtrients clinician

For a limited time, the Essentials Program also includes:

  • The Mindset Reset program – x3 one hour sessions with our hypnotherapist

Expectations.

During the Program, you can expect that your practitioners will:

  • Come prepared.
  • Devote full attention to you during our time together.
  • Serve as your accountability partner and supporter.
  • Stretch you outside of your comfort zone.
  • Offer support, encouragement, feedback and guidance.

We expect that you will commit to the following:

  • You will follow through on the Essentials Program recommendations
  • You will modify your diet based on The Harbor Integrative Health recommendations and your functional lab test findings
  • You will take your recommended supplements
  • You understand that you may be required to keep a record of your food intake
  • You understand that your lifestyle may be a contributing factor to your condition/symptoms and will make modifications within reason (e.g. work demands, sleep habits, relationships).
  • You will do your best to reduce stress.
  • You may be required to change your home and personal care products.
  • You will engage in the exercise regimen recommended by Harbor Integrative Health
  • You understand that you may need to repeat your functional lab tests.
  • You will utilize all resources made available by us to maximize your success
  • You will notify your practitioner immediately if you have any concerns regarding your program.
  • You realize that your health concern(s) may take longer than 6 months to improve.
  • You realize that there may be times that you need to see a specialist in addition to Harbor Integrative Health.

Scheduling and Timing.

Scheduling Appointments:  Appointments can be scheduled online using these links:

For clinical appointments with Mel Hopper Koppelman, you can use this link.

For nutrition and lifestyle appointments with Corrine: you can use this link.

For Mindset reset appointments with Gilliant: you can use this link.

Any e-mails or calls to practitioners related to your Program are for quick questions and you will receive brief responses. If you want to discuss something at length with us, we may request that we wait and discuss your question at our next appointment. Please come prepared to start and end your appointments on time.

Rescheduling:  If you need to reschedule an appointment, you need to do so at least 48 hours in advance of your scheduled time by using the ‘Change/Cancel Appointment’ Link in your appointment confirmation email.

Cancellation:  Our time together is important.  If you need to cancel your appointment, you need to do so at least 48 hours in advance of your scheduled time by using the ‘Change/Cancel Appointment’ Link in your appointment confirmation email. If you do not cancel or reschedule at least 48 hours in advance, this will be considered a missed appointment.

Investment and Payment.

Investment:   You agree that you are financially willing and able to invest in this Program by choice, and that by so doing, you are not incurring any economic hardship in any way.

  • Your investment is $2,997 and must be made upon enrollment in the Essentials Program.
  • Lab testing and supplements are individualized and not included in the Essentials Program fee.

Refund Policy:  At Harbor Integrative Health, we pride ourselves on bringing tremendous value to the lives of our patients. By enrolling in The Essentials Program, you are receiving a comprehensive program consisting of a multitude of services. Since these services work synergistically to bring our patients results, working with patients through a program allows us to provide a better price than offering each service a-la-carte. If you choose to withdraw from our Empowered Living program at any point after the initial consultation, you will be back-billed for any services rendered. See details below.

If you do decide to cancel, you will be charged for all services ($300 per hour) and materials provided prior to the date of cancellation. The total of these costs will be deducted from your program payment. All refunds will be subject to a 3% refund processing fee based on the amount that was paid. After these deductions, the remaining balance of your program payment will be refunded. If you received services or materials in excess of the amount paid, you will not be held responsible for the difference. All payments made for lab tests and supplements are non-refundable.

Confidentiality.

Confidentiality is important to us. We will keep all information exchanged between us during the Program confidential. We will not disclose any information that you share with me during the Program to anyone else unless: (1) they have a legitimate reason to know such information as a member of my team or staff, (2) when required by law, or (3) you have given me prior written permission.

Intellectual Property Rights.

I retain all ownership and intellectual property rights to the Program content and materials provided to you through the Program, including all copyrights and any trademarks belonging to me. The Program content and materials are being provided to you for your individual use. I’m happy for you to share these with friends and family for personal use. However, you are not allowed or authorized to share, copy, sell, post, distribute, reproduce, duplicate, trade, resell, exploit, or otherwise disseminate any portion of the Program or Program materials, electronically or otherwise, for business or commercial use, or in any other way that earns you money, without my prior written permission. 

Personal Responsibility, Disclaimer & Release of Claims.

Personal Responsibility & Assumption of Risk:  You acknowledge that you take full responsibility for yourself and all decisions made before, during and after your Program.  You accept full responsibility for your choices, actions and results before, during and after this Program, and you knowingly assume all of the risks of the Program related to your use, misuse, or non-use of the Program or any of the Program materials. You understand and agree that you are solely responsible for your results.

Disclaimer:  I have used care in preparing the information provided to you, but this Program and my Program materials are being provided as self-help tools for your own use and for informational and educational purposes only. There are many factors that influence results, so no guarantees can be made as to the results you will experience through this Program. You agree that I am not responsible for your physical, mental, emotional and spiritual health, for your financial earnings or losses, or for any other result or outcome that you may experience through this Program. Nothing related to this Program is intended to be considered medical, mental health, legal, financial, or religious advice in any way. For specific questions related to a medical or mental health situation, consult your own medical or mental health professional. For specific questions related to your financial, legal or tax situation, consult your own attorney, accountant, and/or financial advisor. For specific questions related to religion, spirituality, or faith, consult your own clergy member or spiritual healer. Do not start or stop taking any medications because of anything you have read or received through this Program. Any recommendation of any products is simply offered for educational purposes, and you need to check with your own medical professional before using any of these products on, in or near your body in any way. By signing this Agreement, you agree that you are also consenting to the full Disclaimer which may be found on my website.

Limitation of Liability, Indemnification, and Release of Claims:  I will not be held responsible in any way for the information that you request or receive through this Program, including my services, products, and Program materials and any other information you have received from or through me related to this Program. You agree that you fully and completely hold harmless, indemnify and release me 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 may have against me in the future that may arise from your participation in the Program, including all services, products, and Program Materials, to the extent permitted by applicable law.

Other Important Terms.

Entire Agreement, Assignment, Survivability and Waiver: This Agreement contains our entire agreement. This Agreement may be modified or amended at any time as long as the amendment is in writing and signed by both of us. You may not assign your rights or obligations under this Agreement to anyone else, and the obligations under this Agreement shall survive indefinitely unless otherwise stated in this Agreement.  If I choose to waive or not enforce one or more terms of this Agreement, it does not in any way limit my right to later enforce every part of this Agreement.

Governing Law:  This Agreement shall be construed according to the laws of the County of Bristol in the State of Rhode Island in the Country of the United States.By signing this Agreement, we both acknowledge that we have read, understand, agree to and accept all of the terms in this Agreement. Electronic signatures of this Agreement are permitted and enforceable. You agree that you have had the opportunity to ask me any questions prior to signing, and your signature indicates that you are in agreement with all of the terms of this Agreement.

Practitioner

Name: Mel Hopper Koppelman

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Harbor Integrative Health https://www.harborintegrativehealth.com
Signature Certificate
Document name: Harbor Essentials Agreement
Unique Document ID: 8427d33f588674bb24778f34017d19e72ab577ac
Timestamp Audit
29 January 2019 2:36 pm ESTHarbor Essentials Agreement Uploaded by Mel Hopper Koppelman - mel@harborintegrativehealth.com IP 68.3.153.196