Client Agreement with Teacup Wellness

Thank you for deciding to engage with a Teacup Wellness coach. We are excited to work with you to help you define and achieve your wellness goals.

Please scroll down to review and complete this form and then submit to e-sign your agreement with Teacup Wellness. If you have any questions, please do not hesitate to reach out to us at hello@teacupwellness.org.

TEACUP WELLNESS CLIENT AGREEMENT

This agreement is made and entered into by and between

First & Last Name(required)

hereinafter referred to as Client, and

Teacup Wellness Nonprofit, 9888 W. Belleview Avenue, #5051, Denver, CO 80123, hereinafter referred to as the Company, for the purposes of establishing the contractual arrangement for the Client to receive coaching services from a certified wellness coach contracted to work for the Company.

You are invited to share wellness information so Teacup can share the before-and-after progress of its clients. This information will remain anonymous and will be shared out only as part of compiled progress reports to inform our donors and inspire our clients. We follow HIPAA best practices and our Code of Ethics regarding privacy and respect for our clients’ needs.

Please answer yes or no(required)

Yes, I would like to share my current wellness info below Not now, thanks

Age (optional)

Height (optional)

Weight (optional)

Blood pressure (optional)

Do you have easy access to healthy food? (optional)

Do you have a safe place to get regular fresh air and exercise? (optional)

You are also invited to share your story of recovery and wellness with a writer at Teacup Wellness so we can inspire others with your awesomeness. You are welcome to use a pseudonym if you prefer to remain anonymous. If you agree, we will follow up with you after you have completed your first few sessions with a Teacup coach.

Please answer yes or no(required)

Yes, I would like to share my story with a Teacup writer Not now, thanks

City & State(required)

Email(required)

IN WITNESS WHEREOF, the undersigned have set their hands effective the day and year written below.

(your typed name serves as e-signature)

Please re-enter your first & last name(required)

Date(required)

— and —

Anne Mitchell, Company Representative
Teacup Wellness Nonprofit
hello@teacupwellness.org
June 9, 2021