Please sign and date this form below as your agreement with the following policy.

I hereby attest to the following:

I fully understand that Coach Dino Griffin of Marriage and Life Coaching LLC is neither a licensed Professional Counselor nor therapist, and he does not diagnose or treat disease or make medical diagnoses or treatment procedures.

The services performed whether I person, by mail, telephone, e-mail or online are, at all times, restricted to consultation on the subject matters intended for the best possible state of relational health and maintenance; and do not involve the diagnosing, treatment, or prescribing of remedies for the treatment of disease.

I, the undersigned, understand it is my constitutional right to decide how I wish to care for me relational health. Coach Dino Griffin has not suggested that I cease any current medical or psychiatric care or procedure that my doctor or therapist has deemed necessary for my health. Should I choose not to follow medical or theraputic recommendations made by my medical doctor or therapist, I accept full responsibility for said decision and I will hold Marriage and Life Coaching LLC harmless for any consequences related to my decision.

I am engaging Marriage and Life Coaching LLC solely on my own behalf, and not as an agent for federal, state, or local agencies on a mission of entrapment or investigation.

By signing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.