This form is a legal document that explains the risks taken when a person (“you” or “your”) participates in the digitally-based healthcare programs (the “Brightplate™ Programs”) that Brightplate, Inc. (“Brightplate”, “our”, “us” or “we”) makes available via our website located at www.Brightplate.com (the “Site”) or our mobile applications (“App” or “Apps”).  The Brightplate Programs, the Site, and Apps are sometimes collectively referred to as the “Services.”
 

It is important that you read and understand this document completely. After doing so, you are asked to please complete the bottom portion to confirm that you have read, fully understand, and agree to all of the statements in this document. YOU ACKNOWLEDGE THAT THE BRIGHTPLATE PROGRAMS ARE NOT INTENDED OR APPROPRIATE TO ADDRESS SERIOUS, EMERGENCY, OR LIFE-THREATENING MEDICAL CONDITIONS AND SHOULD NOT BE USED IN THOSE CIRCUMSTANCES. IN THE EVENT OF A MEDICAL EMERGENCY, PLEASE CALL 911 OR YOUR EMERGENCY RESPONDER.

 

You give consent to Brightplate to provide nutrition, diet, and health coaching to you. When you use the Brightplate Programs, you will be communicating or sharing information with a Brightplate health coach and potentially other Brightplate employees or agents acting on behalf of Brightplate in a variety of ways. These may include, but are not limited to, one or more of the following:

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• Interactions via audio, video and/or data communications;

• Electronic transmission of health information, photos, personal information or other data; or

• Use of output data from medical devices, sound and video files.
  You understand that neither Brightplate nor its health coaches are licensed medical physicians or providers. Brightplate does not claim to treat, cure, or diagnose any specific disease or medical condition.

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Brightplate and/or its health coaches will provide nutrition, diet and health advice to you solely based on the information you provide to us. It is your responsibility to provide complete and accurate information. Any misinformation, inaccurate or omitted information may affect our assessments and/ or recommendations for you.

 

The Services provided by Brightplate and its health coaches are intended to help you meet your nutrition, diet and health goals and may complement the care of other healthcare providers, but the services are not a substitute for medical care. Any assessment methods that you participate in will help us develop an appropriate nutrition and health program tailored for your individual needs and help you monitor progress in meeting these goals. It is your responsibility to decide which dietary and lifestyle recommendations to follow and to discuss any potential risks and benefits of these changes with Brightplate and your other healthcare provider(s). It is important that you keep the other member(s) of your healthcare team informed of any changes to your diet and health program as a result of working with Brightplate as well. You understand that Brightplate does not have control over how you may use the information provided and, therefore, Brightplate will not be held responsible for your actions. YOU AGREE THAT, BEFORE USING THE SERVICES, YOU SHALL CONSULT YOUR PHYSICIAN, PARTICULARLY IF YOU ARE AT RISK FOR PROBLEMS RESULTING FROM CHANGES IN YOUR DIET.

 

Because every person is unique, it is not possible to determine in advance how you will progress when starting a Brightplate Program. You understand that no warranties or representations have been made to you regarding the results you will achieve from any Brightplate Programs. You understand that results are individual and may vary.

 

Our Notice of HIPAA Privacy Practices describes how we may use and disclose your health information and how you can access this information.

 

BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT (1) YOU HAVE READ AND UNDERSTAND THE STATEMENTS IN THIS INFORMED CONSENT TO PARTICIPATE IN BRIGHTPLATE PROGRAMS; (2) YOU ARE AT LEAST 18 YEARS OF AGE; (3) YOU HAVE READ AND ACCEPT THE TERMS IN BRIGHTPLATE’S TERMS OF USE, ITS PRIVACY POLICY, AND ITS NOTICE OF HIPAA PRIVACY PRACTICES; AND (4) YOU AGREE TO PARTICIPATE IN THE BRIGHTPLATE PROGRAM FOR WHICH YOU HAVE ENROLLED BY YOUR OWN FREE WILL.

 

 

You have the right to withdraw your consent to the use of the Services, including health coaching, at any time, which you may exercise by providing written notice to support@brightplate.com. The withdrawal of such consent will prevent you from using the Brightplate Programs. We will process your withdrawal at our earliest convenience following receipt of your written notice as described above.