OUR HEALTH PROVIDERS
Elissa Lueckemeyer RDN, LD License #DT81691
Elissa is a licensed and registered dietitian in the state of TX. She is the owner of the private practice, Food 4 Success, LLC.
ETHICAL STANDARDS
As members in good standing with each of their respective colleges, Elissa Lueckemeyer RDN, LD abide by their codes of ethics and are accountable to each of their governing bodies for ethical and professional standards. You may ask to see these codes at any time. Should you feel that an ethical violation has occurred through which you have experienced some measure of harm, you have a right to register a complaint with the Ethics Committee of the Commission of Dietetics Registration.
RECORDS
Records are kept for each client and kept for a minimum of seven years. Your file contains any email correspondence we have exchanged during the program that is relevant to your treatment plan as well as your contact information. Your file also may contain any brief session notes from private sessions we have together, if applicable. This enables us to provide you with the best care possible. Files are stored in encrypted and password protected software.
You are welcome to review your file at any time. No records will be shared with any other parties without your signed permission on a ‘Consent for Release & Exchange of Information’ form. It is your choice whether information is released and you are not required to sign any consent if you are not comfortable with it.
CONFIDENTIALITY
Everything that is said via email or in the context of the conversations between service provider and client is kept confidential. There may be times consultations may be made with another therapist or health professional. This is similar to a physician getting a “second opinion” and can be very helpful in therapeutic treatment. If consultation does occur, identifying information such as your surname will not be disclosed.
There are a few exceptions to confidentiality which you should be aware of:
1. When the client gives written permission (a signed release form) to have information from the counselling sessions communicated to another person.
2. When the client is at risk to hurt themselves or others, as when there is danger of suicide or assault.
3. When there is reason to believe that a child has, is, or may be in danger of sexual or physical abuse or
neglect.
This includes:
a. When domestic violence is reported and there is a child or children in the home
b. When a client discloses that he/she was abused in childhood and there is a possibility that the
abuser may be a danger to other children now. In these situations I am legally bound to report
to Family & Children’s Services
4. When mandated by a court order.
At times it may be suggested that I make contact with other professionals or family members in order to obtain information that will be helpful in your treatment. A signed ‘Consent for Release & Exchange of Information’ form is required and you have the right to refuse your signature. Should information be requested by anyone outside of my office, you will be notified.
If it is not an emergency situation, then signed consent is required and the person/agency requesting the information will not receive it, or be informed you are attending sessions, until the proper signature is received from you. If it is an emergency situation you will be informed via telephone, email or in person, as soon as possible. An emergency situation would be an urgent police, medical or child protection situation. Should there be proceedings before the courts and your records are subpoenaed you will be notified as soon as possible.
YOUR RIGHTS
As a client you have the right:
1. To ask questions at any point in time regarding therapeutic or program procedures.
2. To terminate the program at any time; you may ask me for a list of possible referral sources. (Please see our program refund policy)
3. To be informed of any information, decisions and actions that will affect you.
4. To ask about alternative procedures available for meeting your goals.
5. To review all documentation in your client file.
6. To complain to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). If you are not satisfied with the Privacy Policy in place.
REFUND POLICY
We want you to live a happier, more vibrant life so we are giving you all the tools and support you need to start your path to a healthier lifestyle. Because we want you to experience the amazing results possible in this program, once the program materials have been sent out, there are no refunds for your monthly subscription. I have created this policy so that we are both accountable for your success. We are here to support you every step of the way! Please notify us ASAP if you are wanting to discontinue your monthly subscription by emailing us at [email protected] or call at 210-439-1714.
PROGRAM LENGTH AND FEES
Fees for this monthly subscription are due in full. This fee includes monthly access to our self learning modules, monthly group coaching via Zoom, and monthly access to our EatLove Meal Planning program. Payment can be made via credit card only.
INFORMED CONSENT
By clicking below, I agree that I have read and understand the above information, and agree to the terms of therapy stated above. My Service Provider(s) has adequately answered any questions I have at this point in time (via email).
I understand that our providers are Registered Dietitians and not medical physicians. We do not dispense medical advice, nor will we diagnose or treat any medical condition, but will provide nutritional support and nutrition education for an already diagnosed condition. Our providers provide education to enhance my knowledge of health through the use of whole foods, dietary supplements, and emotional awareness.While nutritional support can be an important compliment to my medical care, I understand these services are not a substitute for medical care. I understand that desired results are not guaranteed.
I understand I have the right to stop following the program at any time, and may ask for a list of referral sources. I understand that it is usually best for Service Providers and clients to make joint decisions about termination of treatment.
My signature below indicates that I am giving my consent for Elissa Lueckemeyer RDN, LD to counsel & support me in The RESET Program. I will make a copy of this for my records.