Co-Parent Consent Agreement

Co-Parent Consent Agreement(Required)
You are required to read through the following terms and conditions. When you have reach the end, checking the box will satisfy the agreement to be submitted.


The Coach and the Parent(s) enter into this contract voluntarily.


A. Role of the co-parent coach: The parent(s) understand that the coach’s role is to facilitate confidential conversations which reduce conflict and build skills for successful communication and decision making. The client(s) and coach work together to co-create the steps each parent is willing and able to take to effectively reach parenting and co-parenting goals. The coach is not an investigator or a decision maker; rather, the coach is a guide and inspiration for creating effective interactional patterns between parents and children.

The coach will provide:

  • welcoming setting for structured conversation
  • facilitation of interest-based conversations
  • mediation at the request of the parties for the purpose of reducing conflict
  • education about child development, positive behavior management, and the impact of conflict on children
  • communication skill-building
  • support for stress-management and self-care

The coach will listen carefully, ask key questions and give insightful feedback that promotes the awareness and skills necessary for successful implementation of positive strategies leading to fulfillment of parenting and co-parenting goals. Additionally, the coach may offer supplementary resources. The coach is not authorized to give legal advice. The coach is not serving in the role of a therapist or social worker. If the coach determines that psychotherapeutic interventions would be helpful for the parent(s), the coach will make a referral to an appropriate therapist or terminate the co-parent coach consent agreement.

The co-parent coach holds no liability for any outcomes or consequences resulting from the coaching process or terms of any coaching agreement.

B. Role of the parent(s): The parent(s) understand that the parent(s)’ role is to answer the coach’s questions as completely and honestly as possible, to engage to the fullest extent possible in the coaching process, to follow through with the positive strategies to the best of the parent(s)’ ability, and to give feedback to the coach as completely and honestly as possible regarding the coaching process and the implementation of the selected strategies.

C. Collaboration between coach and parent(s): The parent(s) understand that coaching is a collaborative process in which the coach and the parent(s) work together to co-create the parent(s)’ goals for parenting and co-parenting, for communication, for self-care and for the coaching process.


A. Appointments: Appointments with the coach shall be scheduled at the direction of the coach or by request of the parent(s) by phone, by email or in person. Coaching sessions may take place in person, over the zoom platform or by telephone. Standard appointments are 60 minutes in length, and the Parent(s) may request additional time over zoom, phone or by email.

B. Communication: The parent(s) may contact the coach by telephone, email or text message. The coach will make every effort to respond within 2 business days.

C. Confidentiality: Any sharing of information between the coach and any other party requires an authorization form signed by the parent(s) giving written permission for a release of information. Either parent may request a conversation or meeting with the coach without the knowledge or consent of the other parent. All communications between the coach and the parent(s) will be private and confidential unless a release of information has been signed and submitted to the coach for the purposes of communicating with other parties.

D. Cancelled or missed appointments: The parent(s) shall pay in full for any cancelled or missed appointments unless 24-hour cancellation notice is given.

E. Obstructions to productive joint meetings: The coach will promptly end any joint session that includes personal criticism or aggressive behavior toward the other parent or to the coach. The party using unconstructive behavior shall pay for the cancelled session.

F. Termination: The parent(s) may terminate services at any time.  The coach may terminate services at any time including but not limited to the following reasons: lack of progress, inappropriate behavior, or lack of payment for services.


The parent(s) shall pay for appointments at the time of service. Alternative arrangements may be made at the request of the parent(s). The fee for an individual appointment is $175.00 and $125 per person when parents meet for a joint session.  Fees for additional time spent in telephone or email conversations are billable at $175.00 per hour, calculated at 10-minute intervals. The coach shall bill the parent(s) monthly with an itemized statement including telephone and email coaching.


The parent(s) understand that the coach is obligated under law to disclose the following information to appropriate authorities: 1) allegations of abuse or neglect of a child, 2) threats of harm to other people or yourself, 3) statements made indicating plans to carry out or hide an ongoing crime, and 4) statements made that reveal a felony crime.

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951 High Street Suite B Worthington, Ohio 43085