I understand that each representative of Primal Fusion has completed all necessary certifying programs, taken numerous seminars, and courses in diet and lifestyle counseling, holistic nutrition, integrative kinesiology, and sports & exercise training. I understand that they are certified to coach, train, consult, and provide counseling on cognitively associated behaviors centered in lifestyle habits with the knowledge to provide professional advice about fitness and wellness, but is not a licensed healthcare provider, and is unable to prescribe medications and/or diagnose disease.

I understand that representatives of Primal Fusion are qualified to implement nutritional, spiritual, emotional and physical therapies to enhance my well-being, comfort, and life goals. I understand that they are not medical doctors, and are not legally permitted to diagnose or treat “disease”, but are qualified and legally endorsed to provide me with holistic advice with the intent to build and maintain health and wellness, provide exercise training and coaching, massage therapy and Neurosomatic Therapies, cognitive-behavioral exercises and mental, emotional and spiritual life coaching. I acknowledge and understand that, in some uncertain terms, they may refer me to a functional or medical doctor, psychologist and or other licensed experts in the field of wellness, should they determine the need to and that it is my choice to accept any or all referrals provided.

I agree to complete all forms provided to me in full before starting my custom designed program; I understand that the success of my program and my goals cannot be delivered without the completion and honest feedback of all forms provided, as well as my full consent, cooperative participation and open line of communication with my coach.

I understand that our correspondence and the information I provide to my coach and/or counselor is confidential and is received in alignment with Texas HIPPA laws. I am also aware and acknowledge that all information collected throughout and for the purpose of my program is kept strictly confidential and requires my consent and signature to share with any person(s) other than my coach and myself.

I understand that information I possess about my health status and/or previous experiences of unusual feelings with physical effort and/or injury may affect the safety and value of my therapy session. I understand that I may feel discomfort and pain during this session and that is to be expected during muscle and tissue release performed by my therapist. I acknowledge that my prompt reporting of unusual feelings during the session itself is extremely important and that I am responsible for fully disclosing such information whether or not requested by the therapist. I understand the helpfulness of reporting any pain or discomfort by levels 1 to 10, and that discomfort is to be expected before relief.

I fully understand that if I miss or cancel a scheduled appointment without 24-hours notice, I will be charged $500.00. However, the balance of the deposit is transferable to an appointment at a later date, provided the next scheduled date falls within one year from the initially scheduled appointment.

I acknowledge that appointment times are reserved and that cancellations must be made 48 hours in advance in consideration of the coach’s planning, as well as other clients on a waiting list for specific time slots. Cancellations must be made by calling OR TEXTING: 512. 468. 1036 (voicemail/text will record date/time). I understand that I will not receive a refund for missed appointments. It is my responsibility to attend my personal training appointments when they are scheduled.

I understand that results obtained from the session vary from person to person and from each visit. I understand that I may feel immediate relief, mobility, flexibility, and overall wellness but that it may also take a few sessions to see improvements depending on the variability and severity of my pain and injuries. I understand that NST can cause symptoms to get worse before they improve.

I understand that nutritional advice is not intended to replace the advice of a medical doctor. I understand that no claim is made as to the certain efficacy of any nutritional protocols.

I acknowledge and understand that some therapies may also include an investigation of my core-beliefs and thinking and that alternative therapies are not intended to replace the advice of a medical doctor. I understand that no claim is made as to the certain efficacy of any alternative therapy protocols.

My permission to participate in this program, including but not limited to physical assessments, exercises, neurosomatic therapy, counseling, and other therapies by me is voluntary. I understand that I am free to stop at any point, if I desire.

I understand that physical exercise has been associated with certain risks, including but not limited to musculoskeletal injury, spinal injuries, abnormal blood pressure responses, and in rare instances, heart attack or death. Every effort will be made to minimize these risks.

Any information that is obtained from me regarding my medical history, fitness level, and progress will be treated as privileged and confidential and will not be released or revealed to any person other than my therapist without my expressed written consent.

I understand that sessions will run approximately one to four hours unless otherwise stated. I acknowledge that a delay to a scheduled session cannot change the session status to anything else except a whole session unless otherwise stated by my provider at that time.

I understand that I will perform an exercise and/or movement test, and may be asked questions about my health and physical well being during my initial consultation. I understand that I may stop whenever I wish because of feelings of fatigue or any other discomfort.

I fully understand that all suggested health, rehabilitation, corrective, strength or performance programs are designed with my health and wellbeing and with my utmost safety in mind. In the event that I may injure myself as a result of my participation in this program, I hereby release, discharge, and waive any and all responsibility of Aleks Rybchinskiy, Sara Gustafson or agents and employees of Primal Fusion Holistic Health & Performance and associated companies and agencies now or in the future, including but not limited to heart attacks, muscle strains, sprains, pulls, tears, broken bones, shin splints, knee, back, or foot injuries and any other illness or injury, however caused, occurring during or after my participation in any of the above programs.

I understand that billable hours are also applied to the work performed and executed by my provider(s) in between scheduled appointments including, but not limited to evaluation and review of my intake forms, due diligence, research and case planning, program development and design, and/or remote support. Practitioner case work requires focused due diligence on the client individually, and outside of scheduled appointments. Assessments, reports, assignments, guidance and continued integration work are necessary to every successful outcome, and these areas of practice outside of my one-on-one appointments are used to spend time on my goals, needs and challenges.

I acknowledge and understand that this time spent researching, developing and integrating the best solutions and guidance for me may vary dependent upon my needs and/or requests, and that upon my request, I may receive a full disclosure of all time billable or used from my credits in increments of 30 minutes (0.50) with added notes to allow myself absolute visibility.

I agree to terms of payment for my chosen program which includes the initial deposit or service fee, and all invoices paid in advance to continuing phases of program levels set out for me.

I agree and understand that all hours of coaching & consulting are billable at the hourly rate and cancellations after the 48 hour window cannot be redeemed as credit and is to the discretion of the coach.

I acknowledge and agree that this Contract is not transferable or assignable. I acknowledge that blocks of sessions are scheduled in advance and confirm and guarantee my spot. I agree to pay for all scheduled sessions at the time of appointment or in advance.

I understand this money is not refundable and all requests are made to and considered by the discretion of the coach or practitioner. I understand this contract and the terms it presents is for the purchase of sessions, billable hours, and any other purchase of services in the future. I acknowledge that this specific contract, and agreement is continuously valid indefinitely.

I understand that I will be charged for the session(s) missed. No refund will be granted for sessions that have not been completed. I understand Austin Primal Fitness & Nutrition, LLC (DBA Primal Fusion) has the right and the authority to terminate the program at any time, with no refund, if I do not follow the program or fail to conduct myself in an appropriate manner.