This Informed Consent ("Consent") is entered into between Align With Amie ("Coach," "I," or "me") and the undersigned client ("Client" or "you") in connection with neuromuscular coaching services.
1. Nature of Services
I provide neuromuscular coaching services delivered entirely online. My coaching is designed to help clients build awareness of the connection between mind and muscle, with the goal of
supporting clients who experience chronic pain and muscular tension through education, guided movement awareness, and behavioral coaching techniques. Coaching sessions are not medical appointments, and no clinical examination, testing, diagnosis, or treatment of any kind is provided as part of this engagement.
2. My Professional Background
I hold an active license to practice chiropractic in the State of California. I want you to understand clearly what that license does, and does not, mean for our work together. I am not acting as your chiropractor, and I am not providing chiropractic care, spinal or joint manipulation, adjustment, physical therapy, or any other service that constitutes the practice of chiropractic under California law. My chiropractic license is not being used or relied upon in any way in this coaching relationship.
No chiropractor-patient relationship, and no doctor-
patient relationship of any kind, is created between us through coaching.
3. Not a Substitute for Medical or Chiropractic Care
Coaching is not a substitute for examination, diagnosis, or treatment by a licensed physician, chiropractor, physical therapist, or other qualified health care provider. If you are experiencing pain, injury, or any symptom that concerns you, I encourage you to consult a
licensed health care provider of your choosing. Nothing said or provided during coaching should be understood as medical advice or as a recommendation to delay or forgo care from a licensed provider.
4. Assumption of Risk
Coaching may involve guided movement, physical awareness exercises, and discussion of your physical sensations and history. As with any activity involving the body, there is an inherent risk of discomfort, strain, or aggravation of an existing condition. You confirm that you are
voluntarily participating in coaching with full knowledge of this risk, and that you are responsible for listening to your own body and for stopping any exercise or activity that causes pain or that you are not medically cleared to perform.
5. Accuracy of Information
You agree to provide complete and accurate information about your health history and current symptoms during intake and throughout coaching. I rely in good faith on the information you provide in guiding our sessions, and I have no independent means of identifying a medical condition that is not disclosed to me or that would require clinical evaluation to detect.
6. Confidentiality
Information you share with me during coaching is kept confidential and is not shared with third parties except as required by law or with your written permission. Coaching is not a licensed health care service, and the information you share with me is not protected under HIPAA or the physician-patient privilege.
7. Emergencies
Coaching is not equipped to respond to medical emergencies. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.
8. Voluntary Participation
Your participation in coaching is entirely voluntary. You may decline any exercise, stop a session, or end the coaching relationship at any time.
By signing below, you confirm that you have read and understood this Consent, that you have had the opportunity to ask questions, and that you agree to participate in neuromuscular coaching on the terms described above.