Teleheath Consent

Reason for Release of Information

This Consent to Use of Telehealth Services (“Telehealth Consent”) is incorporated into the Terra Health Coaching Terms of Service (the “Terms of Service”). In this Telehealth Consent, the terms “you” and “yours” refer to the person using the Service, or in the case of a use of the Service by or on behalf of a minor, “you” and “yours” refer to and include (i) the parent or legal guardian who provides consent to the use of the Service by such minor or uses the Service on behalf of such minor, and (ii) the minor for whom consent is being provided or on whose behalf the Service is being utilized. Capitalized terms used in this Telehealth Consent that have been previously defined in our Terms of Service will have the same meanings as provided in our Terms of Service.

When using the Service, you will be consulting with your Provider(s) solely via the use of “telehealth”. Telehealth involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to, one or more of the following:

  • Electronic transmission of medical records, photo images, personal health information or other data between a patient and a healthcare provider
  • Interactions between a patient and healthcare provider via audio, video and/or data communications
  • Use of output data from medical devices, sound and video files
  • The medical care and treatment provided to you by your Provider(s) through the Service will be provided via telehealth.

The electronic systems used in the Service will incorporate network and so ware security protocols to protect the privacy and security of your information and will include measures to safeguard data to ensure its integrity against intentional or unintentional corruption.

Anticipated Benefits

The use of telehealth by your Provider(s) through the Service may have the following possible benefits:

  • Making it easier and more efficient for you to access medical care and treatment for the conditions treated by such Provider(s) utilizing the Service
  • Allowing you to obtain medical care and treatment by Provider(s) at times that are convenient for you
  • Enabling you to interact with Provider(s) without the necessity of an in-office appointment

Possible Risks

While the use of telehealth can provide potential benefits for you, there are also potential risks associated with the use of telehealth. These risks include, but may not be limited to the following:

  • The information transmitted to your Provider(s) may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the Provider(s)
  • The inability of your Provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you
  • Your Provider(s) may not able to provide medical treatment for your particular condition and you may be required to seek alternative healthcare or emergency care services
  • Delays in medical evaluation/treatment could occur due to unavailability of your Provider(s) or deficiencies or failures of the technology or electronic equipment used
  • The electronic systems or other security protocols or safeguards used in the Service could fail, causing a breach of privacy of your medical or other information
  • Given regulatory requirements in certain jurisdictions, your Provider(s) diagnosis and/or treatment options, especially pertaining to certain prescriptions, may be limited
  • A lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors

Acceptance

Terra Health Coaching is not a healthcare provider, and your Provider(s) will be solely responsible for any medical care and treatment provided or failed to be provided via the Service.

All medical care and treatment you receive from your Provider(s) using the Service will be provided using telehealth.

The delivery of healthcare services via telehealth is an evolving field and the use of telehealth in your medical care and treatment from Provider(s) may include uses of technology different from those described in this Telehealth Consent or not specifically described in this Telehealth Consent.

No potential benefits from the use of telehealth or specific results can be guaranteed. Your condition may not be cured or improved and, in some cases, may get worse.

There are limitations in the provision of medical care and treatment via telehealth and the Service and you may not be able to receive diagnosis and/or treatment through the Service for every condition for which you seek diagnosis and/or treatment.

There are potential risks to the use of telehealth, including but not limited to the risks described in this Telehealth Consent.

Your Provider(s) have discussed the use of telehealth and the Service with you, including the benefits and risks of such and you have provided oral consent to your Provider(s) for the use of telehealth and the Service.

You have the right to withdraw your consent to the use of telehealth in the course of your care at any time, which you may exercise by providing written notice to records@Terra Health Coaching.com. The withdrawal of such consent will prevent you from using the Service. Any withdrawal of your consent will be effective upon receipt of the written notice described above, except that such withdrawal will not have any effect on any action taken by Terra Health Coaching or your Provider(s) in reliance on this Telehealth Consent before it received your written notice of withdrawal.

Nothing in this Telehealth Consent modifies any rights you may have to review or receive a copy of your medical records from your Provider(s), including any information included in such medical records that has been transmitted to your Provider(s) through the Service.

You have read the Notice of Privacy Practices provided to you outside of the Service by your Provider(s) and you understand that your medical information is subject to all applicable laws regarding the confidentiality of such medical information. You have the right to access and amend your medical information as and to the extent permitted under applicable federal and state laws.

You understand that the use of telehealth involves electronic communication of your personal medical information to Provider(s) who may be located in other areas, including outside of the state in which you reside. You understand that it is your duty to provide Terra Health Coaching and your Provider(s) truthful, accurate and complete information, including all relevant information regarding care that you may have received or may be receiving from other healthcare providers outside of the Service.

You understand that it is your duty to provide Terra Health Coaching and your Provider(s) truthful, accurate and complete information, including all relevant information regarding care that you may have received or may be receiving from other healthcare providers outside of the Service.

You understand that each of your Provider(s) may determine in his or sole discretion that your condition is not suitable for diagnosis and/or treatment using the Service, and that you may need to seek medical care and treatment a specialist or other healthcare provider, outside of the Service.

You acknowledge that some photo graphic or other images you submit to the Service and that will be shared with Provider(s) may include portions of all of your breast or genitalia, and you hereby agree to the receipt of such images by your Provider(s) solely for the purposes of such Provider(s) providing you medical care and treatment via the Service.

You understand that you are fully responsible for payment for all services provided by Provider(s) or through use of the Service and that you cannot use third-party insurance.

You understand that you are fully responsible for payment for all services provided by Provider(s) or through use of the Service and that you cannot use third-party insurance.

You represent that (a) you have read this Telehealth Consent carefully, (b) you understand the risks and benefits of the Service and the use of telehealth in the medical care and treatment provided to you by Provider(s) using the Service, and (c) you have the legal capacity and authority to provide this consent for yourself and/or the minor for which you are consenting under applicable federal and state laws, including laws relating to the age of majority and/or parental/guardian consent.

You give your informed consent to the use of telehealth by Provider(s) using the Service under the terms described in the Terms of Service and this Telehealth Consent.

  • CARRIE SHAPIRO

    Carrie is a National Board Certified Health & Wellness Coach, trained at Duke Integrative Medicine. She is also a Certified Yoga Teacher (CYT) through Yoga Alliance, and obtaining certifications in Lifestyle Medicine from ACLM, and Mindfulness-Based Stress Reduction. Living in Sacramento, CA, but with a passion for travel and human connection, Carrie integrates the teachings from each modality to provide a holistic
    and practical coaching approach to clients from all over the world.

  • CECILIA LAPOLLI

    Cecilia is COO of Terra Health Coaching; she is passionate about supporting Terra operations to make sure our patients have long-term success. Cecilia is passionate about diversity and inclusion within the health coaching space and works with a focus on mental health, stress/anxiety management, and whole food nutrition. Cecilia was raised in Napa Valley, CA and is now based on the island of Palma de Mallorca (Spain) where she completed her Masters in Business Administration & Project Management (MBA). Cecilia is trilingual (Spanish & Portuguese) and  studied Health Science Education and Whole Food Plant Based Nutrition. Let's work together to create healthier communities!

  • CHELLE BALTZOR

    Chelle is a National Board-Certified Health and Wellness Coach, Holistic Nutrition, and Whole Foods Culinary Specialist, and a trained Diabetes Prevention Lifestyle Coach. Using evidence-based principles and Lifestyle Medicine Chelle supports women seeking holistic solutions while walking through mid-life and searching for lifestyle improvement, nutrition, and health. Her specialty areas are women’s health issues, peri-menopause, pre, and T2 diabetes, stress management, sleep, nutrition, and mindfulness.

  • CHERYL MARSHALL

    Cheryl Marshall is a Master Certified, passionate, reliable health coach and food for life instructor, who’s been employing the principles of a plant-based diet for over 20 years. She works with African American Women looking to prevent and overcome heart related risk factors by bringing awareness about the importance of heart health. Making a lifestyle change towards understanding the connection between lifelong healthy eating habits, exercise, and stress management for disease prevention is rewarding. If you are ready to take the first steps toward enhancing or changing your lifestyle let’s connect and find a health approach that’s right for you. 

  • DIANE HODGE

    Diane is a Registered Dietitian who loves helping people learn how their lifestyle can impact their health and quality of life, to empower people to make healthy choices. She has helped clients with a wide range of nutritional needs for over 30 years. She has Board Certifications in Diabetes/Renal Nutrition and is a Certified Lactation Consultant.   She believes that healthy living should be doable, accessible and affordable for everyone!

  • JADE WILLIAMS

    Jade Williams, RN is a National Board-Certified Health and Wellness Coach. She is trained as a Lifestyle Medicine Coach through the American College of Lifestyle Medicine, an Integrative Nutrition Health Coach through the Institute for Integrative Nutrition, and a Lifestyle Coach for the CDC’s National Diabetes Prevention Program. Jade has served as a coach, mentor, and facilitator with the Whole Health Institute and the Vanderbilt University Health Coach Certification program.

  • JAMES ROSE

    James is a National Board-Certified Health and Wellness Coach (NBC-HWC) with an undergraduate degree in integrative healthcare, a minor in nutrition, and an emphasis in men’s health. His approach to coaching is informed by evidence-based lifestyle medicine principles and positive psychology. James seeks to walk-the-walk and is uses his experiences as foundational in his understanding of behavior change. His mission is to provide a supportive space openly, warmly, and honestly for men of all ages and stages to thrive.

  • JAMIE TOWNS

    Jamie has been a National Board Certified Health and Wellness Coach since 2018. She lives in Arizona with her husband and their two kids (4 and 2 years old). She loves to read and create art with her kids. Lastly, you can expect Jamie to meet you with curiosity, empathy and humor. "Welcome to coaching, I’m really excited to be on this healthy living adventure with you!"

  • JANET PEARSON

    I’m Janet Pearson and I love to cook! My passion is teaching others how to use real, whole foods to nourish and transform. It starts with daily lifestyle choices and learning what to put on our plates. I have studied with culinary experts, lifestyle professionals, researched data, and have read most plant based cookbooks written. I use recipes as guides to create delicious meals that are economical, nutritious, satisfying, and easy to prepare. Let’s create dishes that you enjoy so you can have the health you deserve for years to come!

  • KATIE MCCORRY

    Katie is a National Board Certified Health and Wellness Coach, pursuing her MSc in Health Psychology who partners with her clients to help them tackle the obstacles holding them back from realizing their best health. Whether dealing with the difficulties of natural life transitions or trying to lessen the impact of chronic illness, Katie meets her clients where they are at supporting their journey to improved health. Katie is also a breath coach and enjoys helping her clients use the power of their breath to help ease stress and encourage mindfulness.

  • LAILA MORCOS ZISSIS

    Laila Morcos Zissis inspires change focusing on WHOLE soul living through strategic planning, mind organization, and connecting to inner wisdom. She is an intuitive and an ICF Professional Certified Coach, National Board-Certified Health, & Wellness Coach, and a Certified MentorCoach who brings evidence-based techniques and visionary solutions to help others move into higher levels of living. She has a passion for helping people remove the blocks hampering their wellbeing to live a joyfully energetic life.

  • LARA VALERIO

    Lara is a registered dietitian with Degrees in biology, nutrition, and a Masters in nutritional science. Her passion for nutrition stemmed from working at a hospital and observing the crucial role of nutrition in recovery from infections, illnesses and wounds. She knows the effects of trauma and chronic disease and is dedicated to help treat and prevent patients towards a functional, healthy and longer life using a strong nutritional platform.

  • LILLIAN SIMON

    Lillian is an RN and a Board-Certified Health and Wellness Coach. She has helped clients deal with various conditions, including diabetes, hypertension, obesity, chronic pain, stress, anxiety, and burnout. Using motivational interview techniques, she partners with her clients to assist them in shifting their mindset by meeting them where they are, calming their inner critic, and assisting them to see the possibilities of reaching their goals.

  • LINDA ROBERTS

    Inspired to help others after experiencing her own massive weight loss and health transformation, Linda became a National Board-Certified Health & Wellness Coach. Trained in Lifestyle Medicine, Emotional Eating and Culinary Habits, she helps clients end the vicious cycle of emotional eating, implement healthy mindset, behavioral and lifestyle modifications that address the root of the problem, restores health, well-being and quality-of-life.She is an empathetic, compassionate coach and believes in her client’s ability to reclaim their life!

  • LYDIA JOHNSON

    Lydia Johnson is a Board-Certified dermatologist for more than 20 years.  In 2020, she embarked upon a passionate journey to utilize her medical knowledge and experience to create a more widespread impact on our health as a Board-certified Lifestyle Medicine physician and certified health coach. Lydia is committed to maintenance of health, total well-being, and disease prevention, empowering others to enjoy lives of optimal well-being through lifestyle behaviors that are accessible to all. 

  • MARGARET PEACOCK 

    Margaret is a Duke University certified integrative health coach and ADCES certified diabetes prevention and care lifestyle coach who partners with clients to look at their lives as a whole, set achievable action steps, establish accountability, and ultimately lead them to their best health. As a meditation instructor, she works to target stress reduction and lower levels of cortisol. She looks forward to partnering with you on your health journey.

  • MARIA CONLEY

    Maria discovered a passion for disease prevention early on in her career as a registered dietitian. Over the last 16 years she has helped thousands of people with chronic disease meet their wellness goals by promoting food as medicine. Many find the whole food, plant-based message she promotes to be grounding in a world filled with much confusion about healthy eating. Maria enjoys partnering with her clients, helping them achieve their goals with her supportive and empowering coaching style.

  • MARIAN BLUM

    Marian is a National Board Certified Health and Wellness Coach, and has been an acupuncturist in private practice for over 20 years. Her passion for lifestyle medicine grew out of a desire to empower her clients to reclaim their health and well being. Since 2012, Marian has earned coaching certifications from Wellcoaches, Wellstart Health, American College of Lifestyle Medicine and a plant-based nutrition certification from eCornell. Marian’s mission is to guide her clients to grow lifestyle habits they love--habits that provide a solid foundation for their thriving.

  • MICHELE LOESCH

    Michele Loesch is a certified Applied Functional Medicine Coach and National Board Certified Health and Wellness Coach. She has a passion for educating, inspiring, and empowering clients to get well and stay well. Michele works with clients to uncover imbalances in the body that may be leading to disease and illness. Michele embraces living a healthy lifestyle, by choosing whole unbroken foods, movement, and
    incorporating mindfulness and stress reduction techniques into her life. She believes everyone deserves the opportunity to learn how to mitigate disease and live a vibrant life.

  • PRISCILLA MARBELL

    Priscilla Marbell is a medical doctor and a National Board Certified Health and Wellness Coach. Having started her career in Medicine in her
    home country Ghana, she transitioned to public health in the US. She specializes in corporate wellness, chronic disease self-management, Type 2 Diabetes prevention, weight loss and lifestyle medicine. Priscilla is a passionate health advocate and strongly believes that “health is wealth.” It is her mission to empower all clients to make sustainable, healthy lifestyle changes.

  • RAJITHA BOMMAKANTI

    Rajitha Bommakanti, RN, BSN, NBC-HWC, CCM, FCN, and culinary coach has been practicing nursing for over 30 years in various medical specialties. She currently works as nurse case manager and as National Board-certified health and wellness
    coach. In her nursing journey, Rajitha has seen gaps in patient care and the impact chronic medical conditions had on her patient’s quality of life.  She wanted to make a difference, so she moved into a
    health coaching/transformation space where she is a health
    partner in educating, inspiring, and empowering people to make
    small changes to their lives to improve their health. Rajitha is a
    habit change specialist.

  • RICHARD ALVA

    Richard is a multiracial global citizen who studied psychology, social work, medicine, plant-based nutrition, diet & lifestyle intervention, organizational leadership, & Spanish/English medical interpreting. He has worked with thousands of individuals utilizing Lifestyle Medicine in a variety of settings since the year 2000. His experiences don’t authorize him to talk down to
anyone – instead, he’s learned that all individuals are of infinite value & that health is a precious & fragile gift to be nurtured & protected.

  • REEM HALWANI

    Reem is a preventive health care provider who helps her clients transform their lifestyle to a standard that fits their vision and values.  Supporting her clients in addressing the root cause of the chronic illnesses, identifying and achieving their personal goals through lifestyle modification and coping with the issues that are causing them distress, anxiety, physical pain and unhappiness is her specialty.

  • ROB WARREN

    Dr. Rob Warren is a Certified Health and Wellness coach. He is a physician Board certified in Family Medicine, Geriatrics, and Hospice and Palliative Medicine. Rob is motivated to help his clients struggling with addiction. Through his own personal journey in recovery Rob is uniquely able to assist his clients not only through substance awareness but complete lifestyle modification . Outside of his practice Rob enjoys time skiing, hiking, and spending time on the water with his family.

  • SARA CUNNINGHAM

    Sara is a National Board Certified Health and Wellness Coach, Exercise Physiologist and Lifestyle Medicine Coach with over 15 years of experience. She enjoys coaching adults who feel frustrated or ‘stuck’ with work/life stress getting in the way of exercise/movement, healthy eating, losing and maintaining weight. Sara is passionate about partnering with clients to create goals around their physical, mental, emotional and spiritual health to make positive lifestyle changes, prevent diabetes and better
    manage their chronic health conditions so they can feel better and live healthier lives.

  • SILVINA LAFONT

    Hi! I’m Silvina, a Spanish bilingual registered dietitian, certified diabetes educator, mother, and health communicator with a special love for physical activity, from neighborhood walks to snowboarding, with an emphasis on playing tennis! I enjoy educating people about healthy lifestyle choices that include eating great nutritious whole foods combined in simple-quick meals and helping them to find ways to move during the day, while saving some time to relax and get enough sleep. Making healthy lifestyle changes can help conserve or improve our bodies’ health, and helping individuals to achieve positive changes is my focus and passion. 

  • STEPHANIE ROSS

    Stephanie is a National Board-Certified Health and Wellness Coach and a Certified Health Education Specialist, and she holds a master's degree in Health Education. Stephanie is passionate about helping people to reverse heart disease risk factors through lifestyle change. She works with physicians and businesses to provide integrative health coaching and small group lifestyle medicine classes.While pills and procedures have their place, Stephanie wants to help you reduce your reliance on them where possible. Through unconditional support and sustainable change, she can help you experience true health and a fuller sense of wellness.

  • TAMI MAIER

    Tami is a National Board Certified Health & Wellness Coach and has a graduate degree in the biomedical sciences. She supports others using her perspective gained in former professional roles as a biomedical scientist and a workplace health and safety officer as well as through her personal proactive management of the chronic condition epilepsy. Tami enjoys soccer, gardening, and hiking in nature. She is passionate about physical fitness, balanced nutrition, brain health, and healthy aging.

  • TERRI SIGGINS

    Terri is a National Board-Certified Health and Wellness Coach, yoga instructor, and nutrition educator. She holds an M.S. in nutrition as well as a M.Ed. and Ph.D. in education. She believes taking care of your own health is one of the most important gifts you can give to yourself and those around you. She enjoys working alongside clients helping them to implement sustainable lifestyle changes that bring them a more fulfilling and healthy life.

  • THERESA DAVIS

    Theresa is a National Board-Certified Health & Wellness Coach. In remission from late stage Lyme disease, Theresa possesses valuable insight into the many challenges one encounters in healing their chronic and autoimmune conditions. Her coaching is rooted in the principles of lifestyle medicine, where you will learn to take control of your well-being and be your own advocate for health.

  • VINCE TUCKER

    Vince is a National Board Certified Health and Wellness Coach who received his initial training and certification from The Mayo Clinic. Vince contracts with multiple businesses and nonprofit organizations in providing both oral and written education on the benefits of plant-based living for personal health, environmental stewardship, and ethical concerns. Vince utilizes positive psychology and a strength-based focus to empower patients to be their best selves. 

  • ZAYNUB ELSHAMY

    I am a Nutrition and Lifestyle Practitioner. Certified in Behavior Modification, Diet Therapy, Holistic Health & Wellness Coaching, Exercise Science & Whole Food Plant Based Nutrition. After my own health transformation of losing 120 lbs and reversing Type 2 Diabetes; my passion became to help every person I can to live their optimal life. Free from chronic disease, overuse of medications and under estimation of the body's natural healing capability. My approach is a simple one--emphasizing proper nutrition, restorative sleep and some daily activity. My focus is on individualized goals, preferences and habit change to form a plan with my clients to help them reach the outcome they desire.
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