Informed Consent Agreement

1.   As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during my coaching calls, including my choices and decisions.  I am aware that I can choose to discontinue coaching at any time.

 

2.  I understand that “coaching” is a Professional-Client relationship I have with my coach that is designed to facilitate the creation/development of personal, professional or business goals and to develop and carry out a strategy/plan for achieving those goals.

 

3.   I understand that coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education and recreation.  I acknowledge that deciding how to handle these issues, incorporate coaching into those areas, and implement my choices is exclusively my responsibility.

 

4.   I understand that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association.  I understand that coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment and I will not use it in place of any form of diagnosis, treatment or therapy.

 

5.   I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with the mental health care provider regarding the advisability of working with a coach and that this person is aware of my decision to proceed with the coaching relationship.

 

  1. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law.

 

7.   I understand that certain topics may be anonymously and hypothetically shared with other coaching professionals for training OR consultation purposes.

 

8.   I understand that coaching is not to be used as a substitute for professional advice by legal, medical, financial, business, spiritual or other qualified professionals.  I will seek independent professional guidance for legal, medical, financial, business, spiritual or other matters.  I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my sole responsibility.

Description: Coaching is partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client in a thought-provoking and creative process that inspires the client to maximize personal and professional potential.

 

Responsibilities:

 

1. Coach agrees to maintain the ethics and standards of behavior set by the International Coach Federation “(ICF)”. www.coachfederation.org/ethics

 

2. Client is responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results. As such, the Client agrees that the Coach is not and will not be liable for any actions or inaction, or for any direct or indirect result of any services provided by the Coach. 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 medical disease.

 

3. Client understands that coaching is not to be used as a substitute for professional advice by legal, mental, medical or other qualified professionals and will seek independent professional guidance for such matters. If Client is currently under the care of a mental health professional, Coach will recommend that Client inform the mental health care provider.

 

4. Client agrees to communicate honestly, be open to feedback and assistance and create the time and energy to participate fully in the program

 

Procedure: The time of the coaching meetings and/or location will be determined by Coach and Client based on a mutually agreed upon time. The Client will initiate all scheduled calls and will call the Coach at the following number or over Zoom video conference for all scheduled meetings. Client will receive the Zoom code upon purchase of available time. If the Coach will be at any other number for a scheduled call, Client will be notified prior to the scheduled appointment time.

Confidentiality: This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Coach as part of this relationship, is bound to confidentiality by the ICF Code of Ethics but is not considered a legally confidential relationship (like in Medicine or Law). The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent. Confidential information does not include information that: (a) was in the Coach’s possession prior to its being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Coach from a third party, without breach of any obligation to the Client; (d) is independently developed by the Coach without use of or reference to the Client’s confidential information; or (e) that the Coach is required by law to disclose.

 

Release of Information: (optional based upon specific situation)

1) The Coach engages in training and continuing education pursuing and/or maintaining ICF (International Coach Federation) Credentials. That process requires the names and contact information of all Clients for possible verification by the ICF. By signing this agreement, you agree to have only your name, contact information and start and end dates of coaching shared with ICF staff members and/or other parties involved in this process for the sole purpose of verifying the coaching relationship, no personal notes will be shared.
 

According to the ethics of our profession, topics may be anonymously and hypothetically shared with other coaching professionals for training, supervision, mentoring, evaluation, further coach professional development and/or consultation purposes.

 

Cancellation Policy: Client agrees that it is the Client's responsibility to notify the Coach 24-hours in advance of the scheduled calls/meetings. Coach reserves the right to bill Client for a missed meeting. Coach will attempt in good faith to reschedule the missed meeting.

Termination: Either the Client or the Coach may terminate this agreement at any time with a written notice.

Limited Liability: Except as expressly provided in this agreement, the Coach makes no guarantees or warranties, express or implied. In no event will the Coach be liable to the Client for consequential or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this agreement, and the Client’s exclusive remedy, will be limited to the amount paid by the Client to the Coach under this agreement for all services rendered up until the termination date.

This is the entire agreement of the parties, and reflects a complete understanding of the parties with respect to the subject matter. This agreement supersedes all prior written and oral representations.

If a dispute arises out of this agreement that cannot be resolved by mutual consent, the Client and Coach agree to attempt to mediate in good faith for up to (certain amount of time such as 30 days) after notice given. If the dispute is not resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.

Thank you!

 

Terms of Service

CANCELLATION POLICY

Cancellation requires 24-hour notice.

 

Due to the fact that I arrange my schedule around planned sessions, all sessions have a “no refund” cancellation policy. If a scheduled session is cancelled with 24 hours’ notice, it may be rescheduled within the same Monday to Sunday week. Session may not be rescheduled after that week’s end. During most weeks, rescheduling will be possible; however, the client might have to select a date and time that is not their first choice.

 

If two sessions are cancelled without 24 hours’ notice, in order to continue working with [company name], the client must sign up for a prepaid, long-term contract. Client will be notified after the second cancellation.

 

In the rare event of my needing to cancel a session, client has two options: another session may be scheduled, or the payment for the cancelled session may be refunded.

NO SHOW POLICY

Clients who are not present within 15 minutes of the session’s scheduled starting time are considered “no show.” Payment is still required in the event of a no show. If a client arrives late for a session, that session will still conclude at the end of the appointed hour.

 

REMINDER TO PARENTS

Please have payment—cash, check or credit card payment—available prior to the scheduled session. Most sessions are paid for online. If you will not be present with your child in our virtual meetings (at times in person), please send payment with him or her if the payment has not already been purchased online. If client arrives to session without payment, session will not take place, and will count as a cancellation (see “Cancellation Policy,” above.)

 

Client agrees to pay [Autonomy LLC], at the rate of [session/package] at the start of each scheduled 50 minute session.

 

Payment must be made by cash, check (made out to [Autonomy LLC]) or credit card. Payment must be made prior to the start of the session. If client arrives without payment, session will not proceed.

 

The undersigned understands and agrees that [Sandra] is not liable for the actions, behaviors, mental or emotional states of the clients that she works with.

This contract is binding between all parties.  By signing, I confirm I have read, understand, and agree with all elements of [Autonomy LLC] policies and contract.

Welcome to coaching!  As we get started, it is important that we have a good understanding as to what our coaching agreement is.  Below are the details of what is included in this agreement between, the Coach, and you, the Client.

 

Services

The services to be provided by the Coach to the Client are:

  •  Cellphone/telephone or Zoom session(s) to be scheduled as mutually agreed upon between the Coach and the Client (or their parent/legal representative, if the Client is a minor).  Additional sessions can also be scheduled as mutually agreed upon.

  • The fee for Wisdom Coaching session(s) is $175 monthly and is payable at the beginning of the coaching term.

 

Coaching will be an ongoing relationship that may take a number of months, although either party can terminate the relationship at any time.

Throughout our working relationship, I will involve the Client in helpful conversations and/or other creative activities. Together, I and the Client will work to help the Client discover and achieve his/her goals.  With the Client’s knowledge and support, and without violating confidentiality of specifics shared in the sessions, I will provide a verbal report to the Client’s parent/legal representative (if the Client is a minor).  This is done to assist the parent/legal representative in understanding the Client’s progress as well as learning how they can continue to provide support and assistance to their child.

Coaching sessions are not therapy sessions or psychological counseling sessions, nor will any coaching sessions be a substitute for counseling, psychotherapy, mental health care or substance abuse treatment. The Client (or their parent/legal representative, if Client is a minor) will seek independent professional guidance for legal, medical, or mental health matters. If, in the course of coaching, I believe it would be more beneficial for the Client to pursue counseling or therapy, I will make that recommendation.  The Client, or parent/legal representative, understands that all decisions in these areas are exclusively theirs, and I, as the Coach, acknowledge that decisions and actions regarding them are their sole responsibility.

 

Confidentiality

Coaching is a confidential relationship and I, as the Coach, agree to keep all information strictly confidential, except in those rare situations where the Client’s records might be subpoenaed by a court of law or where such confidentiality would violate the law.  This can include, but is not limited to, thoughts of harming self or someone else, child abuse, elder abuse, etc. Otherwise, no information or materials will be shared with outside sources or other people regarding our coaching work, except with express written permission of the Client (or parent/legal representative if Client is a minor).

 

Other Details

1. This relationship is for a specific period of the Client’s choosing.

2. Each session will be by phone or Skype and may last up to a maximum of 60 minutes.  Emails are available between sessions.

3. 24-hour notice is requested for cancellation of a coaching session.  “No-shows” unfortunately will not be refunded.

4. DISCLAIMER: The Client (and parent/legal representative, if Client is a minor) is the sole decision-maker in the coaching process. Any and all actions or consequences resulting from the coaching sessions are the responsibility of the Client. The Client (and parent/legal representative) releases the Coach of all liability pertaining to the services rendered in the coaching relationship.

By checking the box to these terms upon checkout, you are agreeing to the these Terms & Conditions, the ICA (informed consent agreement), and the ICF (international coach federation).