Consent Form

Consent and Confidentiality

1) Coach-Client Relationship

A. Coach agrees to maintain all ethics and standards of behavior

B. Client is solely responsible for his/her own physical, mental and emotional well-being, decisions, choices, actions and results in their personal life.

C. Client agrees that the Coach is not and will not be liable or responsible for any direct or indirect result of services provided by the Coach.

D. Client understands coaching is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental
disorder or condition.

E. Client acknowledges that coaching does not involve the diagnosis or treatment of mental disorders. If Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider or coaching relationship.

2) Services and Fees

A. Client agrees on the arranged fee of $50 per session or $250 for a prepaid package of 5 sessions plus a free consultation.

B. Client agrees to pay fees upon booking appointment. Cancelled session will be rescheduled at no additional cost using prepaid balance. Consistent rescheduling or tardiness without proper notification may result in termination without refund or forfeit of session fees.

C. Sessions are an hour long and will be held online in order to comply with social distancing needs. Client will have an option to extend sessions if needed by using prepaid hours or by paying for additional time.

D. Client is not eligible for a refund for any reason except in the case of coach agreed upon early termination. Early termination may be granted due to medical or mental health needs or in such case that the coach is unable to complete agreed upon contract.

3) Confidentiality

A. The Coach will not disclose the Client’s name, identifiable information or relationship without the Client’s consent. This includes all information discussed in Life Coaching Sessions and documentation related to these Sessions.

B. Limits to confidentiality include any situation in which the coach becomes aware of danger that the the client poses to themselves or others.

C. Coach is not responsible for information released by the client or documentation that is gathered illegally or through insecure means. Coach agrees to do everything within personal power to prevent such breaches.

Single Session

$50.00

Package Upgrade

$200.00