Consent Form


Welcome to my coaching practice! I’m glad you’ve chosen to work with me as your Certified Eating Psychology Coach. I want you to have the best experience possible in this relationship. As such, I have included information about our work together, and ask that you sign and date this form at the bottom to show that you have read this document and understand and agree to abide by the guidelines outlined within it. Feel free to let me know if you have any questions or need any clarification.

The Nature Of The Work

Eating Psychology Coaching is a mixture of respectful inquiry, conversation, listening teaching points, experimentation, exploration and well-chosen action steps. It’s designed to help you reach your goals, to properly evaluate and re-adjust your goals when necessary, and help you have an empowered relationship with food and body.

The Role Of The Coach

The role of the Eating Psychology Coach is to assist with the improvement of eating challenges such as weight, overeating, binge eating, body image, chronic dieting, and nutrition related health concerns such as digestion, fatigue, mood, cognition, immunity, and more. Coaching services are not be construed as, or a replacement for psychotherapy, legal counsel, or medical advice. Any and all information provided by Susan D’Addario through The HealthShrink program is not intended to diagnosis or treat illness. Please consult your doctor for all your medical needs. If either of us recognizes that you have an issue that would benefit from medical or psycho-therapeutic intervention, I will also do my best to refer you to the appropriate resources.


Ultimately, the coaching relationship is about you, the client, taking full responsibility for your actions, and your life. You enter into coaching with the understanding that you are responsible for creating your own decisions and results. You agree not to hold the coach liable for any outcomes resulting directly or indirectly from the coaching process.


What you share in our sessions is entirely confidential.  The only circumstance in which you confidentiality would be broken is: If I determine you are imminently in danger of harming yourself or someone else. Also, on The HealthShrink site, you can opt to enter your name and email address to receive website, newsletter and blog updates, gifts and consultations. You may remove your email address from the subscription at any time. I do not sell, trade or transfer any personal information about any of my clients to outside parties.


I will do my best to be honest and straightforward. If there is anything that is not satisfactory for you about our work together, please let me know immediately so that we can take steps to make corrections. I encourage you to honestly tell me what’s going on for you. If I ever say or do something that upsets you or doesn’t feel right, please bring it up. Honesty and trust are critical for successful work. I want this to be an open and safe place for you to come with confidence.

Your Consent

I agree to pay my full account at the time of each session. I understand missed and/or cancelled appointments not give 24 hours advanced notice will be billed at the full rate of consultation (whether initial or follow up).