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BLC Services Policy

Consent

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Services Policy

**BODY LOVE CAFE (BLC) SERVICES POLICIES**

Our Mission is to assist you in achieving physical, spiritual, and emotional well-being using a holistic approach to health. Our Philosophy is to educate and empower you to live in optimal wellness so you may: 


**LOVE YOUR BODY. HEAL YOUR MIND. FEED YOUR SOUL.**  


This approach complements any existing health care program.

Body Love Cafe (BLC) Intent:

The intent of any and all services offered and/or nutritional protocols or lifestyle recommendations suggested by Dr. Zachary and the BLC team is designed to support the natural physiological & biochemical processes of the human body. The purpose is not to diagnose, treat, prevent or cure any disease. All suggested protocols are from a holistic health perspective. As such, BLC does not act as your primary care physician and you must continue to have a medical PCP and keep them informed of all your healthcare activities.

Patients/Clients Outside of CA.

Our practitioners may see patients outside of CA only in the states or provinces they carry a license. Please make sure you are scheduled with the correct practitioner per our website listing. Any questions? Contact the office at Team@BodyLoveCafe.com. Health Coaches may provide coaching and consulting regarding nutrition, supplementation recommendations, lifestyle changes, and health education but does not create a doctor-patient relationship. You must always have a Primary Care Physician that you work with in your hometown even if consulting with one of our MD/PhD/DC/DO/ND practitioners. You agree to keep your doctor informed of all your health and lifestyle changes. Be especially mindful if you take prescriptions and lose weight as many prescribe based on weight. 

Cancellations:

We request a minimum of 48 hours advance notice for any cancellation or rescheduling of your appointment.  This is a consideration to our practitioners.  Short notice or no notice will result in an office visit charge at the regular rate.

Payment of Services:

Payment in full is expected at the time of scheduling or at the time of service.  Body Love Cafe receives payment in cash, check, credit and debit card form. There is a $25.00 fee for returned checks. There are no service refunds. You agree that your credit card on file will be automatically charged for any Body Love Cafe invoice generated such as your visit fee or if a supplement order or lab order is requested. You also authorize Body Love Cafe to automatically charge your credit card for any missed appointments or late cancellations of less than 48 hours in advance at the full service fee. There is no charge for rescheduling or canceling appointments more than 48 hours in advance. I am also responsible for any chargeback fees if for some reason my credit card is declined. This authorization is part of my records and will be treated with privacy, confidentiality and respect. 

Additional time charge:

If a visit goes over the scheduled time (ex. 1 hour) then there will be an additional visit charge in 15 minute increments at the prorated rate. Your credit card on file will be charged after the visit is complete.

Refunds:

Supplements and Lab work is purchased through outside vendors and BLC can not issue any refunds, please only purchase items you intend to use. At BLC you may receive a refund for a service that was prepaid but not used and cancelled with the 48-hour notice before the appointment. There are no refunds for services that have already been fulfilled (ex. after a visit). If you purchase a set of visits/services for a discount in a "package plan" and decide to not use them all - you may receive a partial refund for any remaining balance after calculating the used visits at the normal fee schedule. You may receive a refund for a prepaid visit if BLC cancels the appointment and you do not wish to reschedule. 

Primary Care Physician (PCP):

Dr. Brandy Zachary DC, IFMCP is a Doctor of Chiropractic and specializes in functional  medicine and nutrition operating within the scope of her license. Dr. Zachary is not a medical doctor, does not act as a primary care physician and is not on call, nor are any Body Love Cafe practitioners regardless of license type including MD/DO/DC/ND/PhD. Please maintain a positive, working relationship with your medical doctor, keep him/her informed of your healing activities and continue your regular medical care and check-ups. This applies to all providers/practitioners with Body Love Cafe.  
 
Care During Pandemic

Most of our visits are currently being held remotely and have no risk of exposure to Covid-19 and/or any virus. For visits held in person, we follow strict guidelines per the State of CA and face masks must be worn at all times by both practitioner and patient/client. Surfaces are wiped down between visits and gloves are worn when indicated. We ask that patients/clients do NOT come to an in-person visit if they have traveled within the last 14 days, have been exposed to someone positive with Covid-19 or have symptoms including cough, fever and loss of taste or smell. If you choose to have an in-person appointment you understand that there is still risk of exposure, by attending the in-person visit you assume all risks related to exposure to Covid-19  and agree to not hold Body Love Cafe, Dr. Brandy Zachary or any of the practitioners/staff/employees/contractors liable for any illness or injury.

  

Photo release, Social Media release, Website and Marketing release

You agree to authorize Body Love Cafe, A Zachary Chiropractic Corporation and Dr. Brandy Zachary, DC, IFMCP use of any public reviews (ex. Google, Yelp, Facebook, etc) that you submit or a review emailed to us. These reviews may be used for marketing activities and other online promotions via social media, websites and all printed or digital publications and media in perpetuity. You acknowledge that participation is voluntary, there is no financial compensation and this includes photos, graphics and testimonials. You release Body Love Cafe and Dr. Brandy Zachary, DC, IFMCP of any liability or claims by me or any third party related to the use of photographs, graphics or testimonials in printed or digital media.
 
Updates to BLC Policies

All current updates to our Policies will be immediately applicable to you & all previous signers and posted on the Body Love Cafe website and in our Jane software. You may view them there or request an updated copy emailed to you at any time.

Stopping Medication:

Body Love Cafe practitioners will **NOT** take you off any medication, which can only be done with your prescribing physician. If your goal is to decrease your need for medication, we can suggest a protocol to encourage health and then you may work with your MD to monitor your progress and see if you are able to lower or eliminate your medication dosage over time. Keep your MD informed. 

Emergencies:

In case of an emergency, call your PCP, visit your local urgent care or call 911.
 

INFORMED CONSENT

**OFFICE SERVICES**

Body Love Cafe, A Zachary Chiropractic Corporation (**Body Love Cafe or BLC**) offers a variety of holistic healthcare and/or coaching services including chiropractic, nutrition, bodywork, massage therapy, health coaching, functional medicine, nutritional lab education, all through practitioners operating within their scope of practice. All of these holistic services are collectively referred to as Chiropractic Care or Nutrition Care/Support or Ancillary Services. 

 

**INFORMED CONSENT FOR CHIROPRACTIC & NUTRITION CARE (Which includes all items mentioned above).**

To the patient (or their legal guardian, court-appointed conservator, or agent):  Please read this entire form prior to signing it.  Please ask any questions prior to signing this form if you are unclear about anything in this form.

 

**Chiropractic Adjustments** - This treatment is purposely intentioned movements of bones with the desired effect being to remove interference to nerves, which then allows your body to use its innate ability to heal itself.  Chiropractic adjustments also have the desirable effect enabling muscles, tendons, and ligaments to properly function and blood flow to occur.  Chiropractic adjustments can be made by either the use of hands or mechanical instruments to any bone, viscera, or joint in the body including both spinal and extremity bones.  You may or may not hear an audible sound, which is just air being released from the joint space as bones are moved into their proper positions.

 

**Other Procedures** - There are a number of other procedures used by Doctors of Chiropractic that may be utilized.  Treatment may include chiropractic adjustments, physical therapy modalities (such as stretching, traction, massage therapy, nutrition, health coaching & exercise recommendations, etc.). This informed consent extends to our staff (employed or contracted) bodyworkers (chiropractors, massage therapists, energy workers, physical therapists, acupuncturists), our nutrition advisors (Registered Dietitians, health coaches, chiropractors, nutritionists) to include all BLC practitioners. Additionally, there may be referrals to other associated practitioners in the BLC office or outside doctors/practitioners as necessary, and their treatment should involve the same informed consent with disclosure of risks and benefits as is being done here.  For example, there can be permanent pain as a side effect of surgery as one possible consequence of that procedure.

 

**Potential Benefits of Chiropractic and Associated Care** - The majority of chiropractic patients tend to achieve good to excellent improvement in their physical conditions with chiropractic care.  Improvement can be measured in many different ways, including a reduction in pain, increased range of motion, less stiffness, increased athletic performance, and other ways.  It must be remembered that different people get different results, different people have different pre-existing conditions, and are different ages and occupations (with different types of physical stress).  Your situation is unique, and no guarantees are given.  You will have to determine what results you get for yourself and report them to your Doctor of Chiropractic whether it be via an adjustment, nutritional recommendations, or health education and lifestyle coaching.

 

**Material risks Inherent with Chiropractic Adjustments and Other Treatments** - As with any healthcare procedure, there are certain complications that may arise when chiropractic adjustments and/or other procedures are performed.  These complications may arise when chiropractic adjustments and other care/procedures are performed.  These complications include but are not limited to fractures of bones, disc injuries, dislocations, muscle strains, cervical myelopathy, strokes, radiation exposure, costovertebral strains and separations, and burns.  Some patients feel some stiffness and/or soreness following the first few days of treatment.  The physical exam can temporarily worsen symptoms but is a necessary part of chiropractic care.  The Doctor of Chiropractic will make every reasonable effort during the examination to screen for contraindications to care, but remember it is your responsibility to inform the Doctor of Chiropractic of any conditions that would not otherwise come to their attention. As with any change in diet, exercise, sleep patterns or supplementation, please keep all of your physicians informed (MD, DO, DC, ND). Let your practitioner know if there is no change, a worsening or improvement in your symptoms.

 

**Probability of Risks Occurring** - Fractures are rare occurrences and generally result from some underlying weakness of bone.  Even though a competent history & examination will be performed, it is still possible for some weaknesses of bone to be undetected.  Extremely rare are strokes from vertebral artery dissection which also occur in about one person in 133,000 in general (not related to chiropractic). But are estimated to occur in between one in one million and one in five million cervical adjustments.  Although discs are generally helped with chiropractic care, they can be worsened even to the point of requiring surgical care (although this rarely occurs).  Physical therapy can sometimes burn skin by irritating it, although this is unlikely to occur.  A perspective on the risks of chiropractic care as compared to medical care can be seen by the reported 187,000 deaths that occur every year from medical malpractice, but that the number for chiropractic is typically zero per year. With our nutrition coaching or supplementation recommendations we utilize safe nutrients from properly licensed manufacturers and check for contraindications. It is your responsibility to let your provider know of all existing health conditions, medications and to keep your team of doctors informed. Always inform your Primary Care Physician (PCP) of any diet, exercise or lifestyle changes. 

 

**Consequences of Not Obtaining Chiropractic  or Ancillary Care** - Not obtaining chiropractic care and/or nutritional support will have the effect of not obtaining its benefits such as having your body function at its best ability, reducing pain, peak athletic performance, etc.  Not obtaining chiropractic care may allow the formation of adhesions and reduce mobility which may set up a pain reaction further reducing mobility.  Over time this process may complicate treatment making it more difficult, requiring more time (and money), and less effective when chiropractic care is obtained later in time 

 

**Alternatives to Chiropractic Care & Ancillary Services** - Other treatment options for your condition may include rest, acupuncture, physical therapy, medical care, medications (both over the counter and prescribed), hospitalization, surgery, and others.  If you choose to use other treatment options, you should discuss the risks and benefits with your medical doctor or other providers.  

  

**Care During Pandemic** Most of our visits are currently being held remotely and have no risk of exposure to Covid-19 and/or any virus. For visits held in person, we follow strict guidelines per the State of CA and face masks must be worn at all times by both practitioner and patient/client. Surfaces are wiped down between visits and gloves are worn when indicated. We ask that patients/clients do NOT come to an in-person visit if they have traveled within the last 14 days, have been exposed to someone positive with Covid-19 or have symptoms including cough, fever and loss of taste or smell. If you choose to have an in-person appointment you understand that there is still risk of exposure, by attending the in-person visit you assume all risks related to exposure to Covid-19  and agree to not hold Body Love Cafe, Dr. Brandy Zachary or any of the practitioners/staff/employees/contractors liable for any illness or injury.   

  

**Updates to Informed Consent** All current updates to our Informed Consent will be immediately applicable to you & all previous signers and posted on the Body Love Cafe website and in our Jane software. You may view them there or request an updated copy emailed to you at any time.

HIPPA Privacy NOTICE

Last updated on: 01/25/2021

 

Body Love Cafe, A Zachary Chiropractic Corporation (BLC)

Dr. Brandy Zachary, DC, IFMCP

2872 Ygnacio Valley Rd. #400, Walnut Creek, CA 94598

925-788-6300 - Team@BodyLoveCafe.com

 

THIS NOTICE DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

In the course of your care as a patient or client with any practitioner at Body Love Cafe (BLC), we may use or disclose personal and health-related information about you in the following ways:

 

-Your personal health information, including your clinical records, may be disclosed to another health care provider or hospital if it is necessary to refer you for further diagnosis, assessment or treatment.

-Your health care records, as well as your billing records, may be disclosed to another party, such as an insurance carrier, an HMO, a PPO, or your employer (if they are or may be responsible for the payment of your services.)

-Your name, address, phone number, and your health care records may be used to contact you regarding appointment reminders, to provide information about alternatives to your present care, or to provide other health-related information that may be of interest to you.

-**We may also provide treatment in an “open” or “group adjusting”  or "group nutrition" or "group coaching" environment where other patients may be seen and advised at the same time in close proximity to you.**  This situation would necessitate the discussion of your health, subjective symptoms/treatment, etc. in the presence of other patients. **You may always choose to exclusively participate in private appointments.** 

 

You have a right to confidential communications and to request restrictions relative to such contacts.  You also have the right to be contacted by alternative means or at alternative locations.  Such requests must be made to us in writing.  Such requests are not automatic and require the agreement of this office.

 

If you are not at home to receive an appointment reminder, a message may be left on your answering machine or with a person in your household.  

 

Further, you have the right to inspect or obtain a copy of the information we will use for these purposes.  You also have the right to refuse to provide authorization for this office to contact you regarding these matters.  If you do not provide us with this authorization it will not affect the care provided to you or the reimbursement avenues associated with your care.  

 

Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in the following circumstances:

 

-If we are providing health care services to you based on the orders of another health care provider.  

-If we provide health care services to you in an emergency.

-If we are required by law to provide care to you and we are unable to obtain your consent after attempting to do so.

-If there are substantial barriers to communicating with you, but in our professional judgment we believe that you intend for us to provide care.

-If we are ordered by the courts or another appropriate agency. 

 

You have a right to receive an accounting of any such disclosures made by this office.  Any use or disclosure of your protected health information, other than as described in the examples outlined above, will only be made upon your written authorization.  We normally provide information about your health care to you at the time you receive chiropractic care, bodywork, health coaching, functional medicine, nutritional advice, etc from us.  We may also mail, email or text information to you regarding your health care or about the status of your account. If you would like to receive this information at an address other than your home or, if you would like the information in a different form, please advise us in writing as to your preferences. We use a HIPAA compliant EHR system and email but please keep in mind there are inherent risks in electronic communication. If you would prefer to not utilize email as a form of communication please inform Body Love Cafe in writing and please do not email the office. Sending an email to Team@BodyLoveCafe.com and asking questions pertaining to health or your personal information will be presumed as you granting permission to communicate vie email along with this signed HIPAA form.

 

You have the right to inspect and/or copy your health information for seven years from the date that the record was created for as long as the information remains in our files.  In addition, you have the right to request an amendment to your health information.  As per allowance by HIPAA recommendations & as a non-covered entity, the charge will be 25 cents per page.

 

Requests to inspect, copy or amend your health-related information should be provided to us in writing.

 

We make every effort to follow the state and federal recommendations to maintain the privacy of your patient file and the health protected health information therein.

 

We also make every effort to follow the state and federal recommendations to provide you with this notice of our privacy practices with respect to your health information.  We make every effort to abide by the terms of this notice while it is in effect.

 

We reserve the right to alter or amend the terms of this privacy notice.  If changes are made to our privacy notice, we will notify you in writing as soon as possible following the changes.  Any change in our privacy notice will apply for all of your health information in our files.

 

If you have a complaint regarding our privacy notice, our privacy practices or any aspect of our privacy activities you should direct your complaint to:  Kelly Hurrey, Wellness Director,  Kelly@BodyLoveCafe.com, 925-588-1455 or 925-788-6300 

 

You also have the right to lodge a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Ave, S.W. Washington D.C. 20201.  If you choose to lodge a complaint with this office or with the Secretary your care will continue and you will not be disadvantaged by this office or our staff in any manner whatsoever.

 

This notice is effective (updated)  as of January 18, 2021.  This notice and any alterations or amendments made hereto will expire seven years after the date upon which the record was created.

 

All current updates to our Privacy Policy will be immediately applicable to you and all previous signers and posted on the Body Love Cafe website and in our Jane software. You may view them there or request an updated copy emailed to you at any time.

Practitioner Coaching/consultation services policies

The goal of coaching and consulting is to provide you with practical experience in starting and running a functional medicine, nutrition or wellness practice. 

 

No Guarantee - Results Dependent on Practitioner

We can not guarantee results but will share good practices that have been effective in our clinical experience and in practice by those we have coached and worked with over the years. It will always be incumbent on you to “do the work”, to do your research and take action steps.

 

Not Legal Advice - Not Tax Advice

Dr. Zachary may share experience and practical stories based on her clinical practice or those of clients she has coached or what is considered standard in the industry. However, she is not an attorney and none of the advice shared constitutes legal or tax advice. Please consult legal advice or tax advice when/as needed and note that the laws may different by your county, state or country and often differ by medical license.

 

Scope of Coaching & Consulting

Currently, Dr. Zachary provides practical advice and experience in the following areas:

Setup: mindset, website, naming, structure, systems

Clinical: patient/client flow, visit flow/structure, paperwork/forms/handouts/education, labs, supplements, lifestyle considerations

Business: marketing, management, structure, paperwork & other practical considerations

All advice, recommendations and experience shared is for your benefit but does not guarantee results nor certify legal requirements. It is incumbent on you to make the final decisions for all aspects of your clinical and business practice.

 

Forms, Documents, Links, Videos, Handouts

All materials shared in the coaching process are the property of Dr. Zachary, DocZachary.com and/or Functional Medicine Academy, Inc. If given permission to use and change for your clinical practice, please keep in mind this if for use in your individual practice and does not allow you to share these documents with other practitioners nor allow you to profit from selling them or releasing to the general public. If there is every any doubt, a “gray area” or questions, please contact our office for further clarification.

 

Support, Questions Outside of Coaching Sessions

Individual coaching and package coaching sessions do NOT include any email or phone support between your coaching sessions. Occasionally Dr. Zachary will run a “mentor” program and that would provide email and phone support between sessions. Please ask if you are interested in learning more. Otherwise, please save clinical and business questions for your next coaching session. If you have a scheduling, package, or payment question you do not need to wait and may email or call at any time. Best contact information for those questions would be Team@BodyLoveCafe.com or Rachelle@BodyLoveCafe.com or 925-788-6300.

 

Cancellations

We request a minimum of 48 hours advance notice for any cancellation or rescheduling of your session.  This is a consideration to all our practitioners.  Short notice or no notice will result in an office visit charge at the regular rate.

 

Payment of Services

Payment in full is expected at the time of scheduling or at the time of service in credit and debit card form. There are no service/coaching refunds for services that have already occured. You agree that your credit card on file will be automatically charged for any Body Love Cafe or Functional Medicine Academy invoice generated such as your session fee. You also authorize Body Love Cafe/Functional Medicine Academy to automatically charge your credit card for any missed sessions or late cancellations of less than 48 hours in advance at the full service fee. There is no charge for rescheduling or canceling sessions more than 48 hours in advance. You are also responsible for any chargeback fees if for some reason your credit card is declined. This authorization is part of your digital record and will be treated with privacy, confidentiality and respect. 

 

Additional time charge

If a session goes over the scheduled time (ex. 30 min or 1 hour) then there will be an additional visit charge in 15 minute increments at the prorated rate. Your credit card on file will be charged after the session is complete.

 

Refunds

You may receive a refund for a service that was prepaid but not used and cancelled with the 48-hour notice before the appointment. There are no refunds for services that have already been fulfilled (ex. after a session). If you purchase a set of sessions/services for a discount in a "package plan" and decide to not use them all - you may receive a partial refund for any remaining balance after calculating the used sessions at the normal fee schedule. You may receive a refund for a prepaid session if we cancel the appointment and you do not wish to reschedule. 

Photo release, Social Media release, Website and Marketing release

You agree to authorize Body Love Cafe, A Zachary Chiropractic Corporation and Dr. Brandy Zachary, DC, IFMCP use of any public reviews (ex. Google, Yelp, Facebook, etc) that you submit or a review emailed to us. These reviews may be used for marketing activities and other online promotions via social media, websites and all printed or digital publications and media in perpetuity. You acknowledge that participation is voluntary, there is no financial compensation and this includes photos, graphics and testimonials. You release Body Love Cafe and Dr. Brandy Zachary, DC, IFMCP of any liability or claims by me or any third party related to the use of photographs, graphics or testimonials in printed or digital media.
 

 

Updates to Policies

All current updates to our Policies will be immediately applicable to you & all previous signers and posted on the Body Love Cafe or DocZachary website and in our Jane software. You may view them there or request an updated copy emailed to you at any time.

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