Consent WA

Better Health Coaching Service consent form

MEND Australia Pty Ltd (trading as Better Health Company) is contracted by The Department of Health Western Australia, to deliver the Better Health Coaching Service in Western Australia (WA).

The Better Health Coaching Service is a free evidence-based phone service that provides up to 10 coaching calls over a six-month period, with the option of completing the calls weekly or fortnightly. Coaching sessions are confidential and are conducted by a qualified dietitian or allied health professional, providing support for healthy lifestyle goals.

I understand that the Better Health Coaching Service includes:

– Up to 10 one-on-one phone coaching calls with a qualified health professional, of which if the call is cancelled with less than 24 hours’ notice, it will count as one of your calls.

– A resource pack with materials to support implementing healthy lifestyle behaviours.

– Personalised goal setting and support for healthy lifestyle changes, which may include healthy eating, physical activity, reducing alcohol intake, maintaining a healthy weight, and improving wellbeing.

– Health questionnaires that must be completed before and after the coaching service.

– A closed and moderated Facebook group to support social connectedness though the program.

I agree and confirm that:

The medical information I provide throughout the Better Health Coaching Service is correct to the best of my knowledge. I will tell my Coach as soon as I can if any information changes.

If required, I have obtained approval from a medical practitioner to participate in the Better Health Coaching Service. The requirement for medical clearance may also be identified throughout engagement with the service to assure safety and suitability for continued participation in the service.

If I have any concerns about the suitability of the Better Health Coaching Service or about my health during the Better Health Coaching Service, I will discuss this with my medical practitioner and my coach.

I understand that the Better Health Coaching Service team may inform my nominated and/or referring health professional about my participation in the Better Health Coaching Service and may provide them with a copy of my outcomes (including measurements, participation, physical activity and dietary habits information) after I complete the coaching service.

I understand that all health coaches providing the Better Health Coaching Service are qualified in a relevant health field and have been trained to effectively deliver the Better Health Coaching Service and have all had relevant background checks.

I understand that coaching calls may be recorded for quality assurance and training purposes.

I understand that my personal details (obtained from phone calls and questionnaires) are stored on the Better Health Company’s online data system, which complies with the Australian Privacy Principles (2014) set out in the Privacy Act 1988 (Cth) or any other relevant legislation, code or guidelines that applies to the parties. Better Health Company is required to collect, store, use and disclose your information in accordance with the Australian Privacy Principles (2014) set out in the Privacy Act 1988 (Cth) or any other relevant legislation, code or guidelines that applies to the parties. Please contact the Better Health Company on 1300 822 953 if you would like a copy of the Privacy Policy.

I understand that all data collected and stored on the Better Health Company’s online data system will be securely transferred to the Department of Health WA as part of the contractual agreement between Better Health Company and the Department of Health WA, and stored in accordance with Australian Privacy Principles (2014) set out in the Privacy Act 1988 (Cth) or any other relevant legislation, code or guidelines that applies to the parties.

I consent to The Department of Health WA using de-identified information collected about me during the Service, for research and evaluation purposes. This includes responses to surveys completed and participation information.

I agree to release and indemnify the Department of Health WA, Better Health Company, MEND Australia Pty Ltd, associated organisations, and any shareholders, directors, officers, employees and agents of these organisations from any claims (including claims by third parties), liability, damages and/or costs (including, but not limited to, legal fees) which relate to my participation in the Better Health Coaching Service. This includes but is not limited to any claims relating to personal injury, damage to personal property, consequential loss and any injury or damage incurred in the course of the Better Health Coaching Service. “Consequential loss” includes loss of earnings and any other loss that does not directly result in the ordinary course from the event in question.

If you have any questions or would like to discuss anything contained within this form, please contact the Better Health Company on 1300 822 953 or via www.betterhealthcoaching.com.au/wa