Updated January 17, 2022
Client Agreement & Consent
This Client Agreement and Consent (“Agreement”) is made and entered by and between CDL Consulting Incorporated DBA Mettle Health (“Mettle Health” or “Company”), a Delaware C Corporation, its independent contractors, employees, and agents (collectively referred to as “Mettle Health” or “Company”), and the individual client or representative or agent of client (collectively referred to as “Client” or “You”) and is effective as of the date specified in the first booking confirmation (the “Effective Date”).
1. General Policies
Appointments. When scheduling an appointment or setting up an appointment on Company’s website or portal, please provide the Client’s name, phone number, email address, and chief reasons for consultation.
Client must include any and all third-party participants who will accompany the Client during the appointment. If a third-party participant is a minor, Client must verify that Client is the minor’s legal guardian or parent, and provide express written authorization for the minor to participate and share his or her Personal Information, as that term is defined in the Company Privacy Policy (https://www.mettlehealth.com/privacy-policy) incorporated by reference herein, during the appointment. If a third-party participant is a family member, friend, agent or representative of Client, Client must also provide name, phone number, email address of said participant and verify in writing that Client has permission to share such Personal Information, as that term is defined in the Company’s Privacy Policy, with the Company.
Please try your best to be on time since the appointment must end on time. We ask that payments be made prior to any scheduled appointments.
Appointment Notice and Cancellation Fee: Company requires at least 48 hours’ advance notice prior to cancellation of any scheduled appointment. If you miss your scheduled appointment, or cancel with less than the above advance notice, the Company will charge a cancellation fee in the amount of 50% of the appointment fee. You hereby authorize said cancellation fee herein.
Online and phone communication. Company stores Client records digitally. While Company keeps the data secure according to legal requirements, and maintains the privacy and confidentiality of Client data, you understand that no system is 100% secure. Mettle Health may communicate with Client over the phone, email, or over videoconferencing technology such as through Zoom.com. Anticipated benefits include improved access to Mettle Health and allows for Mettle Health and Client to communicate while in different physical locations. Potential risks include gaps of failures in communication, complicating Mettle Health’s recommendations and advice, notwithstanding reasonable efforts to ensure the quality and reliability of transmitted information. There may be limitations to image quality or other electronic problems that are beyond the control of Mettle Health. Despite reasonable security measures, online communications can be forwarded, intercepted, or even changed or falsified without my knowledge. In addition, the information transmitted to Mettle Health may be insufficient for Mettle Health to provide proper recommendations and advice.
Client understands and agrees that the Company may record, at Client’s request, Zoom.com sessions, and the Company is not liable for any data or security breaches resulting from the same. Furthermore, Client understands and herein agrees that if Client permits Client’s child(ren) to receive or participate in recorded sessions with the Company, Client understands that the Company may store and transmit information, including health and/or personal information, regarding the child(ren) on or from the Company’s Zoom.com account. Client herein expressly agrees to the Company’s Privacy Policy (https://www.mettlehealth.com/privacy-policy) and Terms of Service (https://www.mettlehealth.com/terms-of-service), both of which are fully incorporated herein, by executing this Agreement.
Not a Medical or Psychological Services Provider: Company is not a medical provider and may not provide medical advice or treatment. You should seek medical treatment, care, and follow-up with a licensed medical provider. You agree that you are not engaging Mettle Health for any medical or psychological services. You understand that Mettle Health does not diagnose, treat, or claim to cure any medical or psychological condition, and that Mettle Health’s services are not designed to replace conventional treatment methods of medical or psychological conditions. You also understand that Mettle Health does not offer therapy for emotional or mental disorders.
2. Insurance Practices and Client Financial Responsibility
Payment: Company accepts various credit cards. Company bills to your debit or credit card on file unless you provide alternate payment information and instructions.
Fees. The cost for telephonic and video chat consultations are as follows:
● $220 for one-hour long sessions;
● $495 for three (3) hour long sessions.
No Participation in Insurance Plans or Medicare: Company does not participate in any insurance panels and does not accept payment from any insurance company at this time. Consequently, you are responsible for payment in full at time of service and charges are determined by the Company.
No Responsibility to Determine Eligibility for Benefits: Company is not responsible for determining eligibility for benefits or for assisting you with collecting insurance benefits and has no responsibility to correspond with or telephone or email any insurer.
My Financial Responsibility: Client understands that Mettle Health does not accept insurance or negotiate with insurers, and that Mettle Health’s services are not reimbursed by any insurer. Client is financially responsible for Client’s session and agrees to pay the charges incurred. Mettle Health does not accept partial payment or waive payment. Client also agrees to be responsible for costs and expenses, including court costs, attorney fees and interest, should it be necessary for the Company to take action to secure payment of an outstanding balance.
3. Term and Termination. This Agreement shall commence upon the Effective Date and shall continue until terminated unless a term has been specified on the signature page. Records will be maintained for four (4)years after the termination of the Agreement and thereafter returned to the Client upon request or destroyed. If there is a dispute, or potential dispute, regarding payment, the Company will retain any applicable records concerning the dispute beyond the four (4)-year period.
4. Professional Liability Insurance. Company shall maintain professional liability insurance.
5. Client Representations and Warranties. Client hereby represents, warrants and covenants that: (1) Client has the power, authority and capacity to execute, deliver, and perform its obligations under this Agreement; (2) Client has conducted its own independent due diligence regarding the desirability of entering into this Agreement.
6. Consent to Engage in Consultation
Theory: The theory upon which the Services are based is as follows: Clients or their caregivers dealing with serious illnesses, end-of-life issues, disability or loss, often need to make tough decisions and need to decode medical language offered by the Client’s providers. Mettle Health provides Clients or their caregivers with education and a clearer understanding of palliative care, hospice, or other immediate health challenges and long-term situations. Clients or their caregivers can then make better or more informed decisions regarding the Client’s next steps. Client understands and acknowledges the foregoing to receive education and/or consulting and/or health/life coaching either on behalf of Client or as representative:
A. Required disclosures. Mettle Health is comprised of licensed and/or retired physicians, psychologists, clinician or healthcare provider professionals (“Consultants”). If a Consultant of Mettle Health is a licensed physician, psychologist, or clinician, Client herein acknowledges and agrees that he or she is not acting within his or her scope as a licensed physician, psychologist, or clinician, but is rather acting in his or her limited role as a non-licensed person performing consulting or coaching services on behalf of Mettle Health. You herein agree that the services offered by Mettle Health are not medical in nature, but rather alternative or complementary, such as healing arts services in your state. The services that Mettle Health offers are not licensed by your state or any other state.
Nature of Services: The nature of the services Mettle Health will be providing are as follows (“Services”):
● Providing me with information as requested to aid in healthcare decision making, while not diagnosing or providing medical advice.;
● Helping the Client understand both the potential advantages and disadvantages of choices and options recommended by Client’s licensed medical professionals.
● Teaching and educating the Client about palliative care.
● Teaching and educating the Client about hospice and end-of-life choices.
● Discussing, facilitating, and helping ease the administrative burden of completing end-of-life documents such as advance directive, durable healthcare powers of attorney, POLST’s (Physician orders for Life Sustaining Treatment). Client herein acknowledges and agrees that Mettle Health does not provide legal advice in doing so
● Informing Client of any existing or potential conflicts of interest that may arise when discussing palliative care options, hospice, and/or end-of-life choices.
The nature of the services Mettle Health will not be providing are as follows:
● Making healthcare choices for Client, diagnosing ailments, ordering treatments, or replacing Client’s physician in any way;
● Providing medical, financial, or legal advice and/or the practice of medicine;
● Accepting insurance, so all payments are out of pocket;
● Writing prescriptions; and/or
● Guaranteeing any outcomes or results.
B. No Guarantee: Client recognizes that Mettle Health cannot guarantee results or any specific outcomes. Client is solely responsible for any action taken based on Client’s interpretation of any information presented.
C. Right to discontinue services. Client understands that Mettle Health has the right to refuse to continue delivering services at any time for any reason whatsoever and will refund Client’s payment, prorated for the portion of unused services.
D. Responsibility for Your Self-Care. Client herein agrees that Client is responsible for Client’s own health care decision-making by obtaining any necessary consultations with appropriately licensed health care professionals such as physicians and psychologists. Client understands that Client is responsible for Client’s self-care. Client agrees to communicate critical information as well as Client’s needs, concerns and wants as clearly and promptly as possible. Client expects to learn and advocate on Client’s own behalf when possible. Client may expect to be treated with respect and compassion. Client agrees 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 Client finds that the distressing aspects of the Services provided by the Company create a danger for Clientor for others.
E. Expected Benefits. Client may expect to make better informed decisions regarding healthcare or end-of-life decisions and Client’s stress or anxiety about making these decisions may decrease. However, benefits are variable, unique, and depend completely on the Client. Mettle Health cannot guarantee any benefits or effects but in working with Mettle Health, Client could expect to make better informed decisions regarding Client’s healthcare or end-of-life decisions and Client’s stress or anxiety about making these decisions may decrease. Healing journeys are extremely variable, unexpected events happen and unforeseen challenges arise all the time and Client agrees that Mettle Health cannot guarantee any results.
F. Risks and Alternative Treatment:
Direct Risks: Direct risks include making a decision that Client regrets, receiving incorrect or inaccurate information, misinterpreting information, or feeling worse after receiving information or clarity about a health situation or end-of-life decision. Client will advise Mettle Health if Client experiences the same.
Indirect Risks: Indirect risks include that Client may choose to forgo more recognized or routine approaches of care, that Client may disagree with clinical team’s suggestions, or that Client may make decisions family and friends do not agree with. However, Client understands that Client is hereby advised to continue Client’s conventional care (as applicable, under the treatment of my primary care physician or other relevant licensed specialist).
Client Attestation:
Client has carefully read this information, which is printed in English, and acknowledges that English is a language Client reads and understands, and that Client understands the form. Client does not feel rushed or impaired, nor is Client under the influence of a sedative or sleep-inducing medication. Client represents and warrants that Client is of sound mind and able to understand the nature and consequences of this Consent form at the time the Consent form is signed.
Client accepts and agrees to all of the terms above. Client is free to refuse or withdraw Client’s consent and to discontinue participation in any treatment, service, or research at any time without fear of reprisal against or prejudice to Client. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. Client may request and receive a copy of this form from the Company. If any portion of this form is held invalid, the rest of the document will continue in full force and effect.
Lastly, Client agrees to be legally bound by this Agreement’s terms and conditions, the Company’s Privacy Policy (https://www.mettlehealth.com/privacy-policy) and Terms of Service (https://www.mettlehealth.com/terms-of-service), both of which are fully incorporated herein. To the extent that the terms of either the Privacy Policy or Terms of Service contradict the terms of this Agreement, the terms of this Agreement shall govern. To the extent that this Agreement is silent as to certain terms, the terms and conditions in the Privacy Policy and Terms of Service shall govern.