• Health Coaching Form

    Agreement to do business with Dr. Daniel Farkas, Back to Health Natural Solutions LLC.
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  • Healthy Coaching Policy

  • To best serve you, the Health Coaching Policy should be reviewed in its entirety. Dr. Daniel Farkas best believes that you should be well informed of our expectations and policies as a health coaching organization. To prevent any confusion or misunderstanding on what to expect, Dr. Daniel Farkas requests that you read the information below and sign or initial where indicated 

    1. Based on your medical history and initial consultation, it may be necessary to order lab testing. You will be presented with detailed information on the specific tests recommended. The investment for your initial laboratory tests will also be discussed at that time. Payment can be made via credit card. We do not accept insurance for lab testing, because insurance reimbursement requires that a diagnosis be made for the testing. Diagnosing and treating disease is beyond the scope of Dr. Daniel Farkas' coaching program. Lab testing information and results are provided for educational purposes only. 
    2. The results of your lab test may take up to three weeks from the time the sample(s) is received by the laboratory. Once all results have been received, you will be contacted to schedule a Report of Findings Consultation (ROFC). Please prepare for this with your schedule. We also request that your spouse or significant other join you on the call to help support you with any lifestyle changes that you need to make. After the ROFC, you will receive an electronic copy of all test results via your email address on file. 
    3. In your Reports of Findings Consultation, a coaching plan may be recommended which may include dietary and lifestyle changes as well as Advanced Supplementation. It is not our goal that our clients take supplements long term, however some people need the extra vitamins and nutrients in the initial stages of coaching to address any deficiencies or imbalances made evident as a result of their lab testing. 
    4. All participants in any Dr. Daniel Farkas coaching program are expected to fully partner with Dr. Daniel Farkas in taking personal responsibility for their health. The closer you stay to your recommended coaching plan, the faster you will see results and the better results will be. Consultation can be conducted either by phone (U.S. and Canada only) or through video conferencing via skype.
    5. It is your responsibility to update your contact information, including your address, phone number, and email with Dr. Daniel Farkas.
  • I, * have read and fully understand the information.

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  • Terms of Acceptance

  • When a client seeks health coaching with Dr. Daniel Farkas and we accept the client, it is essential for both of us to be working toward the same objective. Our Health Coaching Programs have one goal. It is important for each client to understand both the objective and the methods that will be used to attain it. This will prevent confusion and/or disappointment. 

    Our Goal

    To locate, analyze and help clients correct interferences to the cellular structure. Interferences come from cellular toxicities and deficiencies. Although most doctors use lab testing to diagnose and treat specific condition, this is not your Health Coach's goal. The sole purpose for lab testing is to locate nutrient deficiencies and toxicities within the body that may be interfering with normal cellular function. Many of these interferences are only made evident through advanced lab testing, which allows our team to have better understanding of what is happening within each client's body on a cellular level. Cells are the most foundational aspect of the human body and play an extremely important role in the function of the entire body. Your Health Coach's goal is to help remove the interferences within the body so that you can function at your maximum health potential. Maximum potential varies from person to another. 

    Particularly, we focus on advanced cellular bionutrition and detoxification. This basically means that our approach to health is to help clients live a lifestyle that provides the cell with the best environment possible so that nutrients can easily get into the cell and so that toxins can easily leave the cell. This includes reducing cellular toxicity and inflammation, which have been linked to some of the most chronic conditions. It also helps the individual maximize their overall health and wellbeing. Our primary methods consist of lifestyle changes through nutrition, physical activity, psychological strategies, as well as supplementation. Our methods have often resulted in weight loss, increased energy, elimination of chronic conditions and symptoms, as well as significant improvement in the client's health and wellbeing. While these results are typical, each person is different and we do not and cannot promise or guarantee any specific outcomes as a result of our coaching. 

    Terms of Acceptance 

    We DO NOT diagnose conditions or disease.

    We offer NO treatment of conditions or disease.

    We promise NO cure from any condition of disease.

    If during the course of your health coaching we encounter any unusual findings, we will so advise you. If you desire advice, diagnose or treatment for those findings, we will recommend that you seek the services of a health provider who specializes in that area. We DO NOT offer advice regarding treatment prescribed by others. OUR ONLY OBJECTIVE is to eliminate interferences to the cellular structure. 

    I have read and fully understand the above statements. All questions regarding the objectives pertaining to my coaching have been answered to my complete satisfaction. I therefore accept coaching on that basis. 

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  • CLIENT HEALTH INFORMATION CONSENT FORM

  • We want you to know how your Client Health Information (CHI) is going to be used in our coaching program and your right concerning those records. Before we will begin any health coaching, we require you to read and sign this consent form stating that you understand and agree with how your records will be used.

    1. The client understands and agrees to allow Dr. Daniel Farkas to use their CHI for the purpose of payment, health coaching and coordination of services such as lab testing.
    2. The client understands that Dr. Daniel Farkas and partnering laboratories transmit health information (such as lab results) electronically via a secure internet connection. Dr. Daniel Farkas has taken all the necessary precautions to enhance all security: Dr. Daniel Farkas cannot be held liable if there's any security breach on the part of the laboratories.
    3. The client has the right to examine and obtain a copy of his or her own health records including test results at any time. The client may request to know what disclosures have been made and submit in writing any further restrictions on the use of their CHI. 
    4. A client's written consent need only be obtained one time for all subsequent coaching given to the client.
    5. The client may provide a written request to revoke consent at any time during coaching. This would not affect the use of those records for the coaching given prior to the written request, but would apply to any coaching given after the request has been presented. 
    6. For your security and right to privacy, we have taken all precautions that we know of to assure that your records are not readily available to those who do not need access to them.
    7. If the client refuses to sign this consent for the purpose of health coaching operations. Dr. Daniel Farkas reserves the right to refuse acceptance of the client. 

     

    I have read and understand how my Client Health Information will be use and I agree to these policies and procedures.

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  • Date: *

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  • We want to help you live in your peak state of health for the rest of your life. It is our goal that during our time of partnering together, you are completely satisfied with the results you receive, and the services that are rendered. Please review our Refund Policy below to ensure that you understand the terms of partnering with Dr. Daniel Farkas. 

     

    Consultations and Lab orders

    Due to the nature of our business, in that Dr. Daniel Farkas is a health service company, lab orders and missed consultations cannot be refunded. We require at least 24 hours notice to reschedule a consultation without forfeiting the initial consultation investment. If a consultation is cancelled or an attempt to reschedule is made within less than 24 hours notice, Dr. Daniel Farkas reserves the right not to issue a refund for the missed consultation. 

     

    Health Programs & Supplements

    Due to the nature of coaching, testing and supplementation, we are not able to provide refunds at this time. 

     

    I acknowledge that I have read and understand Dr. Daniel Farkas' Refund Policy.

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  • NUTRITION INFORMED CONSENT

  • According to the Federal Food, Drug and Cosmetic Act, as amended Section 201 (g) (1), the term "Drug" is defined to mean: "Articles intended for the use if the diagnosis cure, mitigation, treatment, or prevention of disease."

    A vitamin or supplement is not a drug. NEITHER is a mineral, trace element, amino acid, herb, or homeopathic remedy.

    Although a vitamin supplement, mineral, trace element, amino acid, or herb may have an effect on any disease process or symptoms, it is not to be misrepresented or classified as a drug. 

    THEREFORE PLEASE BE ADVISED THAT ANY SUGGESTED NUTRITIONAL ADVICE OR DIETARY ADVICE IS NOT INTENDED AS ANY PRIMARY TREATMENT AND/OR THERAPY FOR ANY DISEASE OR PARTICULAR BODY SYMPTOM.

    Nutrition coaching, vitamin recommendations and nutritional supplementation advice is provided solely to upgrade the intake of essential vitamins, minerals, nutrients, amino acids and/or other essential components used in the body's natural processes. They are also used to supply the body with good nutrition and support the physiological and biochemical processes of the human body.

     

    I have read and understand the above information:

     

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