INFORMED CONSENT AGREEMENT

Last Updated: 1/1/25

1. GENERAL TERMS OF VIRTUAL CARE

By scheduling and participating in virtual naturopathic consultations and wellness planning services with Shana Irish / Maevora Wellness Collective, you acknowledge that:

All services provided are strictly virtual and delivered via phone or video.
These services are intended for educational and informational purposes only and should not replace or be considered a substitute for medical care provided by a licensed physician.
While I will provide personalized holistic wellness recommendations, I do not diagnose, treat, or cure medical conditions.
Clients are encouraged to consult their Primary Care Physician (PCP) before beginning any wellness plan, supplements, or holistic therapies.
Any lab work or diagnostic testing is conducted independently and must be reviewed with your PCP. My role is to interpret results from a holistic wellness perspective rather than a medical diagnostic standpoint.

2. SCOPE OF SERVICES

The services provided by Shana Irish / Maevora Wellness Collective include:

✔ Personalized Holistic Wellness Plans – Tailored guidance for overall well-being, including lifestyle modifications, nutrition, supplements, and mind-body practices.
✔ Support for Women’s Health Concerns – Recommendations for hormonal balance, gut health, adrenal fatigue, burnout recovery, guided detox programs, and overall vitality.
✔ Nutritional and Lifestyle Guidance – Support for optimizing diet, movement, and holistic stress reduction techniques.
✔ Supplement Recommendations – Guidance on integrative wellness supplementation, with the understanding that all supplements should be approved by your PCP before use.
✔ Virtual Consultations Only – All interactions occur remotely, with no physical examinations or in-person testing provided.

🔹 What I Do NOT Provide:
🚫 Medical Diagnosis or Treatment – I do not diagnose or treat medical conditions. If you require a diagnosis, medication, or urgent care, consult your licensed medical provider.
🚫 Emergency Care – If you are experiencing a medical emergency, call 911 or go to the nearest hospital.
🚫 Prescription Medications – I do not prescribe, manage, or discontinue pharmaceutical medications.

3. YOUR PERSONALIZED WELLNESS PORTAL: WHOLE PRACTICE

At Maevora Wellness Collective, I believe that healing should be seamless, accessible, and fully personalized. That’s why I use Whole Practice, an intuitive patient portal designed to give you direct access to every step of your wellness journey.

Through Whole Practice, you can:

✔ Access Your Personalized Wellness Plan – View your step-by-step plan, including lifestyle recommendations, nutrition guidance, and supplement protocols, all tailored specifically for you.

✔ Track Your Food, Habits & Progress – Stay connected with me as you integrate your plan, log meals, track daily habits, and make adjustments in real-time.

✔ View & Purchase Supplements – If a supplement plan is prescribed, you’ll be able to conveniently review and purchase recommended supplements directly from your Whole Practice portal. All supplements are sourced through accessed via your Whole Practice portal via FullScript, ensuring you receive high-quality, practitioner-approved formulas. (at a discount too!)

✔ Review & Schedule Lab Testing – If diagnostic testing is recommended, I will provide lab orders through FullScript for at-home test kits or bloodwork. If a blood draw is required, you can easily schedule an appointment at your nearest Quest Diagnostics center. All fees are covered with your lab kit purchase.

📍 Find a Quest Diagnostics location near you: https://www.questdiagnostics.com/

✔ Schedule Appointments & Follow-Ups – Manage all virtual consultations, follow-ups, and wellness check-ins directly from your Whole Practice account.

✨ Everything you need for your wellness transformation is at your fingertips. With Whole Practice, I provide you with the tools, resources, and expert guidance to make your journey effortless, empowering, and results-driven.

4. PATIENT RESPONSIBILITY & PCP COLLABORATION

It is highly recommended that you share your PCP records with me, particularly lab results and health history, to help guide your wellness plan.
You are responsible for discussing any recommended supplements, therapies, or detox protocols with your PCP before beginning.
By participating in my services, you confirm that you are under the care of a licensed medical provider for any ongoing health conditions requiring medical supervision.

5. LIMITATION OF LIABILITY & ASSUMPTION OF RISK

By engaging in virtual wellness services, you acknowledge and accept the following:

You are voluntarily choosing to participate in holistic wellness coaching and naturopathic guidance with full awareness that these services are not a replacement for licensed medical care.
You assume full responsibility for any lifestyle changes, dietary modifications, supplement use, or wellness protocols recommended.
[Shana Irish / Maevora Wellness Collective] is not liable for any adverse reactions, medical complications, or health issues arising from recommendations.
You waive all claims against Shana Irish/ Maevora Wellness Collective and agree that no guarantees have been made regarding specific health outcomes.

6. INFORMED CONSENT TO PARTICIPATE

By purchasing and scheduling a virtual consultation, you acknowledge, understand, and agree to the terms outlined in this agreement.

✔ I understand that this is a holistic wellness consultation, not medical care.
✔ I accept full responsibility for seeking approval from my PCP before beginning any wellness protocols.
✔ I release [Shana Irish / Maevora Wellness Collective] from any liability related to my health outcomes.

7. PAYMENT TERMS & REFUND POLICY

All payments are due in full at the time of booking.
No refunds will be issued once a session has been completed.
Cancellations or reschedules require at least 48 hours’ notice. Appointments canceled with less than 48 hours’ notice will incur a 50% cancellation fee.
No-shows or same-day cancellations will be charged the full session rate.
Packages must be used within six (6) months of purchase and are non-transferable.

8. COPYRIGHT & INTELLECTUAL PROPERTY

All content, wellness plans, and materials provided through Shana Irish / Maevora Wellness Collective are copyrighted intellectual property and may not be copied, shared, or distributed without written permission.
By participating in my services, you agree not to reproduce, resell, or repurpose any educational materials, wellness plans, or supplement recommendations for commercial purposes.

9. AGREEMENT & SIGNATURE

By booking an appointment, you acknowledge that you have read, understood, and agreed to the terms outlined in this Informed Consent Agreement.

✔ I understand that this is a virtual holistic wellness consultation, not medical treatment.
✔ I acknowledge that it is my responsibility to consult with my PCP before implementing any recommendations.
✔ I release Shana Irish / Maevora Wellness Collective from any liability related to my participation.

Your signature will be collected electronically at the time of onboarding.

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