Parental Agreement

This document includes Health Coach practice and policies and guidelines set forth to allow me
to best assist you with my services. Please read each guideline and type your full name in the
response box below stating you understand, acknowledge, and agree to the terms. Please sign
your name at the bottom prior to submitting.

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I understand that the role of the Health Coach is not to diagnose or prescribe, and does not replace or override medical advice from your child’s practitioner/pediatrician.

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I understand that the information received from health coach (Shannon Sciametta) are tailored for my child's individual needs and are intended only for myself (parent/guardian) and should not be shared with others or posted on social media.

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I understand that emails between appointments are intended to clarify questions/concerns pertaining to current protocol or treatment plan.

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I understand that emails should not be used as an open forum for discussion on matters not pertaining to the current treatment plan, protocol, or child’s progress.

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I understand that emails should contain simple, targeted questions that are able to be answered in 1-2 sentences each; not paragraphs. If further discussion is needed outside of that parameter, I understand I may be asked to schedule a 30-minute appointment when necessary.

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I understand that Health Coach (Shannon Sciametta) may not be available to respond to emails on weekends and holidays. I understand that Shannon may take vacations and my not have access to emails during those time, but I will be informed of that beforehand.

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I understand when scheduling an appointment that the time will be displayed in Eastern Standard Time (EST), and that it is my responsibility to covert the time appropriately to my time zone/region. I understand that failure to do so may interfere with the schedule and could warrant a cancellation. I will email Shannon prior to an appointment if I need clarification on date or time.

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I understand that working with a Health Coach involves a team effort, but I am ultimately responsible for implementing my child’s treatment. I understand that Shannon will do her best to advise the best recommendation she sees fit for my child based on their needs with her experience and education. I understand that I will be educated on each recommendation, but there is no way to predict how my child will respond. I understand that there is no guarantee that my child will have a positive outcome, as each child is unique.

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Parental Agreement

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