Wellness Consent template

1. Nature of the Programme

• This wellness programme may include activities such as coaching, movement, nutrition guidance, mindfulness, or group workshops, aimed at supporting general wellbeing. It is not a substitute for medical, psychological, or clinical treatment.

2. Health Disclosure

• I confirm I have disclosed any medical conditions, injuries, or limitations relevant to my participation, and that I am responsible for informing my provider of changes to my health.

3. Risks and Benefits

• Participation may involve physical activity and carries some risk of strain or discomfort. Many participants experience improved wellbeing, though results vary and are not guaranteed.

4. Confidentiality and Data Protection

• My personal information is kept confidential and processed under the UK GDPR and Data Protection Act 2018.

5. Voluntary Participation

• My participation is voluntary and I may withdraw from the programme at any time without penalty, subject to the cancellation terms of any package purchased.

Client Information

• Full NameText
• Date of BirthDate
• Relevant Health ConditionsText
• Phone / EmailText

Provider Information

• Provider / Facilitator NameText
• Programme NameText

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Provider SignatureSignature
• Date signed (provider)Date

• By signing below, I confirm I have read and understood this consent form and voluntarily agree to participate in the wellness programme.