Please complete the Consent Form and come back to booking again. Thank you! Click Here
If, after reading this form you are at all unclear about any of the information provided or do not agree to consent, please contact your health coach prior to your appointment so your concerns can be addressed.
Health and Wellbeing coaching services
Healthy Business deliver Health and Wellbeing Coaching services, both onsite face to face and remotely via phone/telehealth incorporating the HealthCI program. HealthCi is a holistic program that addresses health and wellbeing under four key health pillars: mental health, physical health, lifestyle habits, sleep, and fatigue. These services aim to help participants identify health and wellbeing concerns, and to understand and encourage behaviour change through education and personalised support.
As part of providing a health and wellbeing coaching service to you, trained Healthy Business coaches perform standardised recording of health metrics including;
Please click the box below to demonstrate your understanding that as part of the Health and Wellbeing Coaching service, health metrics may be captured and recorded.
I UNDERSTAND THAT AS PART OF THE PROVISION OF HEALTH AND WELLBEING COACHING, HEALTH METRICS MAY BE CAPTURED AND RECORDED
Additionally Healthy Business will collect self-rated scores from participants in the four key health pillars (“HealthCi”).
Occasionally these scores or measures may be deemed to be of a high concern and/or an acute risk to your physical or mental health and wellbeing. If this occurs, your health coach will take steps to manage these risks. This document forms part of the informed consent for services performed by your Healthy Business health coach and your consent to participate in the program, including procedures in the event of a high or acute risk presentation to a coaching session.
This collection/collation and referral (which may include referrals to other treatment providers that may be able to better support your wellbeing needs) will be a necessary part of the initial and ongoing health and wellbeing consultation process inclusive of Health Ci that is conducted at your place of employment.
Purpose of collecting and holding information
Your results are gathered as part of your health coaching and kept securely and, in the interests of your privacy, used only by your health coach, and the authorised personnel of Healthy Business (any health coach providing coverage) in accordance with Healthy Business policies and procedures. The information that is relevant to your current personal situation is collated and documented within your coaching session and this enables the health coach to provide relevant and informed coaching services to you. As part of a Healthy Business program, Healthy Business does provide statistics and reporting to the employer which includes aggregated (group) data, health trends and data change and statistics. None of your personally identifiable data/or individual personal information is passed on to your employer unless you specifically request this or if required to by law.
Consequence of not providing personal information
If you do not wish for your personal information to be collected in a way anticipated by this letter or the Privacy Policy, Healthy Business may not be able to provide the Health and Wellbeing coaching service to you.
Access to personal information
At any stage you are entitled to access your personal information kept by Healthy Business subject to exceptions in the relevant legislation. Your health coach will inform you of how this can be facilitated. In the event of the Healthy Business program at your workplace ceasing you will be notified before your data will be scrubbed entirely, beyond this date nobody including you will be able to access your data.
Please click the box below to demonstrate your understanding of the collecting and holding of your personal information.
I UNDERSTAND THE PURPOSE OF COLLECTING AND HOLDING PERSONAL INFORMATION AS PART OF THE PROVISION OF HEALTH AND WELLBEING COACHING
Disclosure of personal information
All personal information gathered by the health coach during the provision of the coaching service will remain confidential except when:
Failure to disclose the information would in the reasonable belief of Healthy Business, place you or another person at serious risk to life, health, or safety; or
It is subpoenaed by a court, or if disclosure is otherwise authorised by law
Your personal information will not be used, sold, rented, or disclosed for any purpose.
If unauthorised access, disclosure, or loss of a client’s personal information occurs, Healthy Business will activate its ICT security plan and use all reasonable endeavours to minimise any risk of consequential serious harm.
PLEASE TYPE THE FOLLOWING TO INDICATE YOUR PROVISION OF CONSENT
I, (print your name in Block Capitals) …………………………., have read and understood this Consent Form. I agree to the above conditions for the health and wellbeing coaching service provided by Healthy Business.
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