HEAD HEART HANDS, LLC
Disclosure & Consent
Head Heart Hands, LLC, owned and operated by Ritu Saluja-Sharma, M.D., and its employees and agents (collectively, “Company”), provides an informational and educational online platform with educational articles and pre-recorded video modules designed to teach participants about their potential for better health. With respect to the material provided and taught by Company (“Content”), whether through a website or online video module, I understand and agree to the following:
Disclosure -- Education and Training: Ritu Saluja-Sharma, M.D. is licensed as a medical doctor in the states of Maryland, Virginia, and Washington, D.C., but she is operating in the capacity of a health educator only, and, she is not necessarily relying on her medical license in providing the Content. Thus, the services contemplated hereunder may be considered alternative or complementary to licensed healing arts services.
Description/Nature of Services: The nature of the services Company will offer are as follows: health education. This involves providing information about common diseases to client (such as obesity, cardiovascular disease, and diabetes) and guiding, assisting, educating, and supporting clients to make thoughtful, manageable lifestyle adjustments to improve overall well-being and vitality through the use of a variety of general nutritional guidance, and/or exercise, stress management, sleep hygiene, and general coaching techniques to achieve more optimal health and weight loss goals. The Company primarily educates and supports clients to assume more personal responsibility for their health by adopting a healthier attitude, lifestyle, dietary, and exercise approaches. In addition, Company will be providing nutritional suggestions or giving recommendations concerning proper nutrition, which means the giving of information as to the use and role of food and food ingredients, including dietary supplements. I understand that any and all nutritional recommendation is not intended as diagnosis, treatment, or prescription and is based solely on Company's own research and opinion. Lifestyle recommendations include optimizing sleep which includes but is not limited to proper sleep hygiene, relaxation techniques, hydration, and self-care practices like meditation and journaling.
Theory: The theory upon which the services are based is as follows: health education involves attuning the client to their own health goals, metrics, and habits, so clients can release limiting beliefs, clarify their values, increase self-efficacy, and achieve overall self-improvement.
These services include online access to: (1) 24 pre-recorded health education and learning video modules discussing the science of wellness and health optimization; and (2) 12 pre-recorded health coaching video modules (collectively, the "Content") to address mindset approaches for implementing lifestyle changes and setting goals. The modules have been designed to educate and inform you about the overall function of specific body systems (example: thyroid), the science behind common diseases, factors related to lifestyle and environment, and nutritional information and advice concerning the role of food, food ingredients, and the microbiome related to overall health and wellness and weight loss.
Benefits, Alternatives & Risks: Benefits of the above services include receiving health information and education that can augment my overall health and improve my healthcare decision-making, as well as overall lifestyle and nutritional support and overall balance. Alternatives include visiting licensed healthcare clinicians in person as appropriate. Risks include over-relying on health education and information; however, I am committed to monitoring my own health needs and seeing a physician, psychologist, or other licensed healthcare Company in an appropriate capacity when medically necessary. I understand that my overall health may be compromised if I am missing an organ or have been through major surgery, and that Company cannot possibly address all risks to my health from these situations. Furthermore, I understand that I am responsible for monitoring my own condition throughout any recommended physical activity and/or exercise, and should any unusual symptoms occur, I will cease participation and immediately inform my primary care physician of my symptoms. Such symptoms during physical exercises could include but are not necessarily limited to: nausea, difficulty in breathing, chest discomfort, and joint or muscle injury.
Information and Education Only: The information provided pursuant to these services is educational and informational in nature and is provided only as general information. The information is not intended to create and does not constitute any professional relationship between Company and me, nor does it create any doctor-patient or any other professional relationship. The information is not intended to solicit clients or patients; and should not be relied upon as medical, psychological, or other professional advice of any kind or nature whatsoever. Even if those providing information via the online telehealth format display professional licensure or other credentials in the healing arts, or cite clinical trials or other medical literature, they are limited to providing information and education, and are not providing any clinical service. The information provided should not be used for diagnosing or treating a health problem or disease. The information contained in these communications is not comprehensive and does not include all the potential information regarding the subject matter, but is merely intended to serve as one resource for general and educational purposes.
No Medical or Psychological Services: I am not engaging Company for any medical or psychological services. I understand that Company does not diagnose, treat, or claim to cure any medical or psychological condition, and that Company’s services are not designed to replace conventional treatment methods of medical or psychological conditions. Company does not handle medical emergencies of any kind. I am responsible for my own health care decision-making by obtaining any necessary consultations with appropriately licensed health care professionals such as physicians and psychologists. I agree to seek medical assistance or psychotherapy or any other appropriate physical or mental diagnosis and treatment from a duly licensed practitioner (such as a licensed medical doctor or licensed psychologist) if I find there to be any distressing aspects of the services that could create a danger for myself or for others. Never disregard or delay medical advice received from your licensed healthcare provider based on information in the Content. Always consult your physician, psychologist, or licensed healthcare provider before seeking any new treatment, or before you alter, suspend, or initiate any change in your medical or psychological treatment, medication, or herbal supplement, routine, or procedure.
Not Replacing Current Medical Care. Company is not replacing care currently provided to me by physicians or licensed healthcare providers, such as my current primary care physician, internist, gynecologist, cardiologist, gastroenterologist, pediatrician (in the case of children) or other specialty care. Company has advised me that Company does not admit patients to the hospital or treat hospitalized patients, and that I should maintain a relationship with a physician who is available to provide emergent and urgent care. If I encounter a medical emergency and am not able to obtain care from my primary care physician, I will contact 911 or report to a hospital emergency department.
Dietary Supplements. Dietary supplements are marketed for general well-being, or as intended to affect the normal structure or function of the human body – for example, “calcium builds strong bones.” Thus, although we may provide information about dietary supplements with a specific therapeutic purpose in mind, manufacturers and distributors are prohibited from making drug or therapeutic claims for dietary supplements, and their use in clinical practice is chiefly designed to support general well-being or certain aspects of metabolic function. While most dietary supplements are generally considered safe, efficacy has not been conclusively established; and in some cases, adverse reactions can occur if the client is concurrently using pharmaceutical medications (drugs). For this reason, it is important to keep all of your healthcare providers fully informed about all medications and dietary supplements you may be taking.
No Claims or Guarantees: I understand that Company makes no representations, claims or guarantees that my medical problems or conditions will be cured, solved, or helped by Company’s Content. Expected benefits are variable, unique, and depend completely on the client. Company cannot guarantee any benefits or effects but in working with Company, I could expect that if protocols are followed and I participate consistently, I will come closer to my goals, including weight loss goals, especially if I am committed to long-term work. Results are extremely variable, unexpected events happen, and unforeseen challenges arise all the time, and Company cannot guarantee any results.
No Designations Allowed: I understand that I am not authorized by Company to represent or designate myself as a Company practitioner nor to represent that Company has approved or endorsed my use of the Content (whether in a therapeutic setting or otherwise). I understand that Company may present me with copyrighted materials owned by Company and that I may not disseminate the same without Company’s advance written authorization.
Testimonials and Endorsements: Consumers generally may not be expected to achieve the same or similar results as others who have received services and who have subsequently written or recorded video testimonials and endorsements. Company may post testimonials for informational purposes only; Company does not claim that anyone will experience the same or similar results as mentioned in these writings or video modules. Nor does Company claim that a significant number of consumers may obtain similar results. Results experienced by any one individual who has written a testimonial or endorsement, is not necessarily what any given consumer should expect to experience. Any information that could be regarded as a testimonial or endorsement in connection with these services does not constitute a guarantee, warranty, or prediction by us regarding the outcome of any past, ongoing, or future conversation or interaction with me.
Right to discontinue services: I understand that Company has the right to refuse to continue delivering services at any time for any reason whatsoever and will refund my payment in full for the portion of unused services.
My Responsibility for My Self-Care. I understand that any inner-directed work or reflection can bring up distressing feelings, images, thoughts and behaviors. I agree to seek medical assistance or psychotherapy or any other appropriate physical or mental diagnosis and treatment from a practitioner duly licensed (such as a licensed medical doctor or licensed psychologist) if I find that these distressing aspects create a danger for myself or for others.
Assumption of Risk; Indemnity: I knowingly, voluntarily, and intelligently decide to receive the services described above, and I knowingly, voluntarily, and intelligently assume all risks involved in the same. As a result of my assumption of these risks, I agree to release, hold harmless, indemnify, and defend Company from and against any and all claims which I (or my representatives) may have for any loss, damage, or injury arising out of or in connection with use of the Content described above. As a result, I agree not to pursue a claim against any of the foregoing, if I am dissatisfied with the results of the above services.
Limitation of Liability: Company is not liable to me or any third party for any damages (including, without limitation, direct, indirect, incidental, special, consequential, exemplary, incidental, special, or punitive damages, personal injury/wrongful death, lost profits, good will, use data or other intangible losses (whether or not I have been advised of the possibility of such damages)) or damages arising from or relating to this Consent or any other agreement, even if advised of the possibility of such loss or damages, and whether under negligence or some other theory of liability. Because some states do not allow the exclusion or limitation of liability for consequential or incidental damages, in such states, liability is limited to the fullest extent permitted by law. Notwithstanding the above, Company's sole liability for any reason to me, and my sole and exclusive remedy for any cause or claim whatsoever, shall be limited to the amount paid by me for services or other service provided by Company, and, must be brought within one (1) year since the event giving rise to such action occurred. I understand and agree that my participation with respect to receiving services is predicated upon my waiver of any right to participate in a class action suit for any losses or damages resulting from the same.
Arbitration. Any dispute, claim, or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in Gaithersburg, Maryland, before one (1) arbitrator. The arbitration shall be administered by the American Arbitration Association ("AAA"), in Gaithersburg, Maryland. Judgment on the award may be entered in any court having jurisdiction. This provision shall not preclude either party from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. The arbitrator may, in the award, allocate all or part of the costs of the arbitration, including the fees of the arbitrator. Each party has read and understood this Section (Arbitration) and understands that it thereby agrees to submit any claims arising out of this Agreement to binding arbitration, and that this dispute resolution provision constitutes a waiver of the Party’s right to a jury trial. HOWEVER, prior to either party initiating Arbitration of any dispute, the parties agree to attempt mediation of the dispute with a mutually agreeable trained mediator in the county of San Francisco. “Trained mediator” means a professional with actual training and experience in the field of Mediation and/or dispute resolution. EACH PARTY HAS READ AND UNDERSTANDS THIS SECTION and UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, THE PARTY AGREES TO SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT, OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH, OR TERMINATION THEREOF TO MEDIATION AND ARBITRATION, AND THAT THE DISPUTE RESOLUTION PROVISIONS SET FORTH IN THIS SECTION CONSTITUTE A WAIVER OF THE PARTY’S RIGHT TO A JURY TRIAL.
NOTE: DO NOT SIGN THIS FORM UNLESS YOU HAVE READ IT AND FEEL THAT YOU UNDERSTAND IT. ASK ANY QUESTIONS YOU MIGHT HAVE BEFORE SIGNING THIS FORM. DO NOT SIGN THIS FORM IF YOU HAVE TAKEN MEDICATIONS WHICH MAY IMPAIR YOUR MENTAL ABILITIES OR IF YOU FEEL RUSHED OR UNDER PRESSURE.
I have carefully read this form and acknowledge that I understand it. I have had opportunities to ask questions, and accept and agree to all of the terms above. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. If any portion of this form is held invalid, the rest of the document will continue in full force and effect.