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.
  • BETH WEGLARZ

    Beth is aNational Board CertifiedHealth and Wellness Coach,an advanced practice nurse with deep experience in treatment and education related to Pediatric Nutrition. She is a NBCHWC, Exercise Fitness Specialist and a Lifestyle Medicine advocate for all things physical and mental health. Beth resides in Long Island, NY and remains dedicated to creating programs to promote human health and well being through many different avenues and has joined Terra to bring that dedication to our members.

  • 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 a certified Integrative Wellness Coach that is passionate about helping folks achieve radiant health. She believes in the power of lifestyle medicine and plant-based nutrition as the base of success. Cecilia studied Public Health in her undergrad, she completed eCornell’s Plant-Based Nutrition Course, and graduated from the Health Coach Institute. She is now living on the island of Mallorca, Spain completing her MBA.

  • 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 is a Certified Health Coach and Food for Life Instructor, who's been employing the principles of a plant-based diet for over 20 years, including raising her four children on a plant-based diet. She's the founder of VegUcan Health & Wellness LLC, an organization designed to encourage healthy habits and lasting lifestyle changes for individuals. She knows how the power of food over health and well-being, and thrives in knowing that she can make a difference and empower progressive change in others, while simultaneously embarking on a personal journey of self-improvement and empowerment!

  • DAWN WOODS

    Dr. Dawn Woods is aNational Board CertifiedHealth and Wellness Coach, apharmacist, a board certified lifestyle medicine professional, a certified health and nutrition life coach, and a certified vegan health coach. Motivated by the desire to have enough energy for her two young children, she changed her entire lifestyle and lost 40lbs. Implementing appropriate protocols of lifestyle medicine to prevent, treat, and reverse chronic diseases, especially diabetes, and weight loss therapy are activities that drive and inspire her.

  • 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.

  • 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!

  • JANINE GILARDE

    Janine Gilardeis a Registered Nurse, National Board Certified Health and Wellness Coach, Lifestyle Medicine Coach and Culinary Nutrition Coach. Janine’s mission is to motivate her clients to achieve healthier, sustainable, lifestyle habits. Whether you want to manage your stress, weight, or chronic conditions, or you want to learn how to prep quick and nutritious meals, Janine can help you create your own path to well-being so that you can be healthy, with more energy, better focus and a sense of calm.

  • KATHLEEN BELONGA

    Kathleen is Lifestyle Medicine Certified Health Coach with certifications in functional nutrition, yoga, mindfulness, Ayurveda, and a Masters in education and leadership. She works closely with midlife women who are ready to embody a healthier lifestyle. Kathleen has a passion for good food and believes food should be our first source of healthcare. She specializes in helping clients transition to a whole food plant-based diet, develop healthy ways to manage stress, move the body, and create sustainable lifestyle routines.

  • DR. KATHY S. SOVEROW

    Kathy’s Ph.D. is in MindBody/Lifestyle Medicine and accompanied by NBC-HWC, ACC, LMC, Trauma-sensitive HeartMath® certifications. Having been a CBT for 30+ years, integrating coaching
    psychology within her skill set was seamless. Kathy is an adjunct professor serving as dissertation chair/committee member for DHSc students at the University of Bridgeport (CT). At Saybrook University (CA) she teaches coaching (Integrative Wellness Coaching Department) and serves
    on dissertation committees (Ph.D.).

  • 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.

  • KRISTINA RODRIGUEZ

    Kristina is a certified functional medicine practitioner, registered nurse, psychedelic integration guide, massage therapist, and therapeutic yoga instructor living in Maui, Hawaii. She draws upon her comprehensive knowledge base to help guide your transformational process- physically, mentally, emotionally, & spiritually. By encouraging you to listen to your own internal guidance and by using the best that lifestyle medicine, psychedelic therapy, and somatic healing arts have to offer she lovingly resources and empowers you along your journey.

  • 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.

  • LAUREN BOCK

    Lauren has been a PA since 2007 with experience in Internal Medicine/Primary Care and Preventive Cardiology. She brings great passion and a wealth of knowledge to the Lifestyle and Wellness community. She loves helping her clients achieve optimal emotional and physical health, preventing and even reversing diseases such as hypertension, obesity, high cholesterol and diabetes.  

  • LILLIAN SIMON

    Lillian has been helping others with their mental health since 1995. As a Bengali-American and abuse survivor, she has learned to manage her mental health. She is a registered nurse and certified health coach who partners with clients to manage their mental health and lifestyle diseases. Clients appreciate her calm demeanor and reflective listening skills. In her free time, she writes for her Christian mental health ministry, Balm From Gilead.

  • 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.

  • MIA BOGATU

    Mia is a NBHWC Health Coach and an ACE Fitness GFI fromHouston, TX! For the last 6 years, she has been working in the health and fitness industry, and as a Health Coach. Mia has assisted more than 500 people to build a healthier lifestyle. Her coaching style is focused and goal-oriented and she uses motivational interviewing techniques. As your Coach, Mia aims to help you achieve your ULTIMATE GOAL by setting small actionable goals, and she will help you overcome the obstacles that arise.

  • MICHELE LOESCH

    Michele Loesch is a certified Integrative Nutrition Health Coach and Board Certified with the National Board of Health and Wellness Coaches. She has a passion for educating, inspiring, and empowering clients to get well and stay well. Michele embraces living a healthy lifestyle, by choosing whole unbroken foods, movement, and incorporating mindfulness and stress reduction techniques into her life.

  • PATRICK PARKINSON

    Patrick is a Health Coach who is passionate about connecting client values to healthy behaviors. Patrick spent the bulk of his career in the medical device industry where he came to recognize the shortfalls of treating symptoms over addressing the true cause of disease. This experience along with his success managing his own chronic vestibular condition through lifestyle deeply motivate Patrick to share the power of Lifestyle Medicine with others. Patrick is certified in Plant-Based Nutrition through eCornell.

  • 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.

  • SARA CUNNINGHAM

    Sara enjoys coaching adults who feel frustrated or ‘stuck’ with work/life stress getting in the way of exercise, eating healthy, losing & maintaining weight. She is a Certified Health and Well-being Coach, Exercise Physiologist and Lifestyle Medicine Coach with over 15 years of experience. 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 live healthier lives.

  • SHERRIE EVENSON

    Sherrie is a National Board Certified Health & Wellness Coach and a 40-year exercise professional. She is a Master’s-level Certified Clinical Exercise Physiologist, employed in a hospital-based Cardiopulmonary Rehab program for over 25 years. Sherrie is dedicated to the principles of Lifestyle Medicine, helping people discover their best health potential through sustainable lifestyle choices.

  • SHRUTI HEGDE

    Shruti's name means to "hear" and she is eagerly waiting to listen and be a resource for you to achieve the health goals you have been pursuing (physically, mentally, socially, and spiritually), by way of a more plant based nutrition strategy and simple Lifestyle changes. Shruti made the change herself in 2011 and it's been an amazing journey bringing abundant health and happiness into her life. She is happy she can be that person who can walk with you in your new journey and help you to make the right decisions to lead your life in a very holistic way!

  • 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 Mayo Clinic trained health and wellness coach and a Lifestyle Medicine coach. Vince contracts with multiple businesses and nonprofit organizations in providing both oral and written education on the benefits of plant-based living. Vince utilizes positive psychology and a strength-based focus to empower patients to be their best selves. Vince is studying for the October National Board for Health & Wellness Coaches exam.

  • 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.