Please read each statement below and type your full name stating you acknowledge and agree to each. When complete, please sign your name at the bottom then submit form.

I consent to participate voluntarily in Mom2Mom Coach’s services and I recognize this Program may contain certain inherent risks. I take full responsibility for my child’s life and well-being and all decisions made before, during and after using these services. I agree to observe and obey all posted rules and warnings, and further agree to follow any instructions or directions given by Deepika Mahalingam.

I understand that the information provided at or in conjunction with the Mom2Mom Coach services, including dietary recommendations and/or supplement advice is not intended to be a substitute for professional medical advice, diagnosis or treatment that can be provided by my physician, therapist, licensed dietitian or nutritionist, or any other licensed or registered health care professional.

I understand that Mom2Mom Coach is not a medical or mental health care provider and is not providing health care, medical or nutrition therapy services or attempting to diagnose, treat or cure in any manner whatsoever, any disease, condition or other physical or mental ailment of the human body. Rather, they are serving only in their capacity as coaches, educators, mentors and guides.

I agree to seek the advice of my child’s pediatrician, physician or another qualified health care professional prior to and during services regarding any questions or concerns I have about my child’s specific health situation, known or suspected food sensitivities or allergies, dietary restrictions, or any medications my child is currently taking. I agree to not disregard professional medical advice or delay seeking professional advice or start/stop taking any medications without speaking to my child’s pediatrician, physician or health care professional.

I understand that no claim is made as to the certain efficacy of any nutritional or supplement protocols. I understand that adopting any of these recommendations to implement for my child is voluntary and by choice.

Any information that is obtained from my medical history, treatment plans and coaching services will be treated as privileged and confidential and will not be released or revealed to any person other than my healthcare providers without my expressed written consent.

In the event that my child becomes ill or injured as a result of my participation in Mom2Mom Coach’s services, I hereby release, discharge, and waive any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands which I have ever had, now have, and could have in the future against Deepika Mahalingam and/or Mom 2 Mom Coach, arising from my participation in anything related to these services, now or in the future.

I understand that the information and recommendations received from Mom2Mom Coach are tailored for my child’s individual needs, and are intended only for myself (parent/caregiver) and should not be shared with others or posted on social media.

I understand that I need to provide a 48-hour notification if an appointment needs to be rescheduled or cancelled. I understand that the balance is due during the time of appointment booking and there are no refunds under any circumstance.

I have carefully read this document and by signing below I consent to all parts of it. I understand that by signing this release, I voluntarily surrender certain legal rights.