Healthcare & Wellness
Nutrition and Diet Coaching Agreement
Coaching agreement for nutrition and dietary guidance covering health disclosure, scope of services, and payment terms. Two signers (nutritionist and client).
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# Nutrition and Diet Coaching Agreement **Effective Date:** ___________ This Nutrition and Diet Coaching Agreement ("Agreement") is entered into by and between: **Nutritionist/Coach:** ___________ ("Nutritionist") **Credentials/Certifications:** ___________ **Client:** ___________ ("Client") ## 1. Services The Nutritionist agrees to provide the following services: **Service Type:** ___________ **Session Format:** ___________ **Session Duration:** ___________ **Session Frequency:** ___________ **Program Duration:** ___________ ## 2. Health Disclosure The Client represents that they have disclosed all relevant health information: **Current Health Goals:** ___________ **Known Medical Conditions:** ___________ **Food Allergies or Intolerances:** ___________ **Current Medications or Supplements:** ___________ **Dietary Restrictions:** ___________
Fields (26)
effective date
date · required
nutritionist name
text · required
credentials
text · required
client name
text · required
service type
select · required
session format
select · required
session duration
select · required
session frequency
select · required
program duration
select · required
health goals
textarea · required
medical conditions
textarea
food allergies
textarea
medications
textarea
dietary restrictions
select · required
eating disorder history
select · required
program fee
text · required
fee structure
select · required
payment method
select · required
payment timing
select · required
cancellation notice
select · required
cancellation fee
select · required
termination notice
select · required
early termination fee
text · required
governing state
select · required
nutritionist signer name
text · required
client signer name
text · required
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