Patient Details

Nutrition Counseling Onboarding

Tell Us About Yourself

(or your dependent, the patient)

First Name *

Last Name *

Email Address *

Phone Number

Date of Birth *

Gender *

Occupation *

Address Line 1 *

Address Line 2

City *

County *

Postcode *

Country *

Nutrition Counseling Onboarding – Step 2

Agreement

The specifics of your personalized nutrition plan are incorporated into this Agreement. You agree to the following in light of our preliminary communications and your receipt of counseling sessions:

Counseling Sessions

Welcome to VEXA precision nutrition counseling. Please make every effort to keep your appointment. Please reschedule at least 36 hours in advance or you may be charged for the entire session. If you start a consultation more than fifteen (15) minutes late, there is a possibility the entire session will be canceled. There is leeway for emergencies. If you do not show up for your appointment, you will be charged the full appointment fee.

Extras

If you have scheduled a follow-up session after our most recent session, you can contact me via email at andreea@vexahealth.com. Please do not hesitate to email any questions or comments you may have along the way. You will not be charged for email responses that take less than approximately ten minutes.

Fees and Payment

You agree to the designated fees at the time of purchase. Payment is made via Calendly/Stripe and must be made in advance of services.

Privacy

Client information and records are kept private unless you give advance permission to disclose them or unless required by law. All of our conversations and information exchanged are compliant with the Data Protection Act 2018 and also HIPAA-compliant.

Dietitian Responsibilities

The Dietitian (Andreea Nitescu RD MSc) is expected to listen to their client and their wishes and work within that guideline where possible. Guidelines will be agreed prior to all sessions in order to ensure the client is aware of what behaviour will/will not be accepted. The goal of each session is to work through any setbacks that the client may currently be facing, clarify all goals through exercises and locate methods to move their client forward on their goals.

Client Responsibilities

You agree to cooperate by completing questionnaires/food logs/other assessment materials on time so that productive consultation can take place. You understand that as a Client, you are accountable for your actions. It is your sole responsibility to contact your physician for permission to participate in the consultation if you are unable to do so due to medical reasons. You acknowledge that any activity in which problems/life situations are discussed carries some risk, which you, the Client, agree to accept completely.

Client Name *

Client Signature *

Date *

Nutrition Counseling Onboarding – Step 3

Policies

Lateness & No Show Policy

Packages and dietitian sessions must be used within 120 days of the purchase date. After this time, dietitian sessions and packages become invalid. There is no transferability for any sessions or packages.

Cancellation Policy

Please contact the dietitian by phone, email, WhatsApp and/or other mutually agreed-upon means of communication at least 36 hours in advance if you are unable to show up for a scheduled session; failing to do so will result in full payment for the session. At the dietitian's discretion, modifications may be made and appointments may be rescheduled. A session is due to the client if the dietitian cancels it.

Refund Policy

Packages and consultation sessions are not refundable. Exceptions may be made in extenuating circumstances.

Expiration Policy

Please contact the dietitian by phone, email, and/or other mutually agreed-upon means of communication at least 36 hours in advance if you are unable to show up for a scheduled session; failing to do so will result in full payment for the session. At the dietitian's discretion, modifications may be made and appointments may be rescheduled. A session is due to the client if the dietitian cancels it.

Complaints Policy

If for any reason you are unhappy with the services you receive, please email us at feedback@vexahealth.com, describing your experience. Please keep in mind the dietitian cannot prescribe treatment or diagnose medical conditions. They may at any time ask to consult with your doctor should any mental health or medical condition arise.

Nutrition Counseling Onboarding – Step 4

Waiver of Liability

Declarations

This Agreement is entered into between Vexa Health Ltd., and the undersigned (“Client”). The provision of nutritional services by the Dietitian to Client, and Client’s use of any premises, facilities or equipment are contingent upon this Agreement.

Assumptions of Risk

I acknowledge that I am aware that Vexa Health Ltd., its members, officers, agents, employees and independent contractors are not medical doctors and do not diagnose disease. I also affirmatively state that I have disclosed any and all known medical or genetic conditions, medications I use, and any significant personal or family medical history. Any recommendations that I follow for changes in diet, including but not limited to the use of food supplements, are entirely my choice and my responsibility. I am knowingly assuming any risk associated with nutritional counselling.

In consideration of my participation in nutrition counselling, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release Vexa Health Ltd., its members, officers, agents, employees and independent contractors from any liability whatsoever to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness, injury or other harm to my person, including my death, that may result from or occur during my participation in nutrition counselling, whether caused by the sole or concurrent negligence of Andreea Nitescu (Vexa Health Ltd.), its members, officers, agents, employees and independent contractors.

I further agree to indemnify and hold harmless Vexa Health Ltd., its members, officers, agents, employees and independent contractors, to the fullest extent permitted under law, from any and all liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described nutrition counselling session.

Nutrition Counseling Onboarding – Step 5

Informed Consent

I,

Enter Name *

grant Vexa Health Ltd. permission to provide Nutrition Counselling to myself or the client for whom I am legally responsible. The consultation will provide information and guidance on health factors that are within my control, such as my diet, nutrition, and lifestyle. I understand that the goal of nutritional counselling is to promote wellness, a healthy attitude, lifestyle, and diet, and that results cannot be guaranteed.

While nutritional support can be a valuable addition to my health and disease management, I recognise that these services are not a replacement for medical care. I understand that nutritional counselling is an important supplement to health and disease management, but it is not a replacement for medical diagnosis, treatment, or medical physician care. Furthermore, I agree to provide a complete and accurate account of any medical conditions I may have and any medications I am currently taking.

The nutrition evaluation or testing methods made available to me are not meant to diagnose disease. Rather, these assessment tests are intended to serve as a guide in developing an appropriate health-supportive programme for me, as well as to track my progress toward my goals. Unless I consent to sharing my medical information, Vexa Health Ltd. will keep my medical records, personal information, and history confidential.

I hereby release and discharge Vexa Health Ltd., their officers, agents, employees, and persons acting on their behalf, from all claims, demands, costs and expenses, and causes of action arising out of or in any way connected with services I receive from Vexa Health Ltd. I have carefully read this consent form and the terms contained within it. I fully understand the terms of this form and freely agree to be bound by them.

Client Name *

Client Signature *

Date *

Nutrition Counseling Onboarding – Step 6

Privacy Notice and Optional Consent Choices

How we use your personal information

We collect and use personal information so that we can provide nutrition and dietetic services to you safely and effectively.

This may include your name, contact details, date of birth, appointment information, health information, dietary information, lifestyle information, medical history, test results or recommendations, payment information, and records of the care and support we provide.

We process your personal information in accordance with the UK GDPR, the Data Protection Act 2018 and other applicable privacy laws.

Why we use your information

Purpose	What this involves	Lawful basis
Providing nutrition and dietetic services	Providing consultations, follow-up reviews, tailored nutrition advice, meal plans or subscription plans; recording your progress; managing your care.	Performance of a contract and/or legitimate interests. Where health information is used, this is processed for healthcare provision and under professional confidentiality obligations.
Appointment administration	Booking, changing or cancelling appointments; sending appointment reminders; contacting you about recommendations, test results or service-related updates.	Performance of a contract and/or legitimate interests.
Legal, regulatory and professional duties	Keeping appropriate clinical and business records; meeting safeguarding, insurance, accounting, tax, complaints-handling, clinical governance and record-retention obligations.	Legal obligation and/or legitimate interests.
Payments and financial administration	Issuing invoices and receipts; processing payments; maintaining accounting records; preparing financial and management reports.	Performance of a contract, legal obligation and/or legitimate interests.
Service improvement and feedback	Asking for feedback, reviewing complaints, improving our services, identifying and fixing problems, and developing service quality.	Legitimate interests.
Dispute resolution and legal claims	Using relevant information where necessary to establish, exercise or defend legal claims.	Legitimate interests and/or legal claims.

Health information

Because we provide nutrition and dietetic services, we may process information about your health, diet, lifestyle, medical history and care needs. This is special category data under UK GDPR.

We process this information where necessary for the provision of health or care services and where it is handled by, or under the responsibility of, a professional subject to confidentiality obligations.

Marketing communications

We will only send you marketing communications, such as offers, promotions, newsletters or information about new services, where we are allowed to do so under data protection and electronic marketing laws.

You can opt out of marketing at any time by contacting us using the details below or by using any unsubscribe option provided in our messages.

Marketing consent is optional. You do not have to agree to marketing in order to receive our services.

Testimonials and feedback used publicly

We may ask whether you are happy for us to use your feedback as a testimonial on our website, social media or other marketing materials.

We will only publish testimonials with your permission. Testimonials will always be anonymized before publication. However, even anonymized comments may sometimes identify someone depending on the wording or context, so we will ask for your specific consent before using your feedback publicly.

You can withdraw permission for future use of your testimonial at any time by contacting us. If your testimonial has already been published, we will take reasonable steps to remove it from materials we control.

Your rights

You have the right to:

access the personal information we hold about you;
ask us to correct inaccurate or incomplete information;
ask us to delete your information in certain circumstances;
ask us to restrict how we use your information in certain circumstances;
object to certain types of processing, including direct marketing;
ask for a copy of your information in a portable format where applicable;
withdraw consent at any time where we rely on consent.

Please note that some rights are not absolute. For example, we may need to keep certain health, clinical, or financial records where we are required or permitted to do so by law, professional guidance, insurance requirements or for the establishment, exercise or defense of legal claims.

How to contact us

VEXA Health Ltd.
Email: info@vexahealth.com
Phone: +44 (0)7942 642207
Address: 128 City Road London EC1V 2NX

Optional consent choices

Please tick any options you agree to. These choices are optional and you can withdraw your consent at any time.

I agree to receive marketing communications, including offers, promotions, newsletters and information about new services.

I agree that my feedback may be used as an anonymized testimonial on the website, social media or other marketing materials.