Coaching Consent Agreement

Consent Agreement for Coaching(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 Client(s) enter into this contract voluntarily.


A. Role of the Coach: The Client(s) understand the Coach’s role is to facilitate conversations which promote client growth in the areas of personal and/or professional development, communication and interpersonal skill building, self-awareness and self-care. The Coach will listen carefully, ask key questions, facilitate learning and give insightful feedback that promotes successful creation and implementation of vision strategies and goals. The Coach is not serving in the role of a therapist. If the Coach determines that psycho-therapeutic interventions would be helpful for the Client(s), the Coach will make a referral to an appropriate therapist.

The Coach holds no liability for any outcomes or consequences resulting from the coaching process or terms of any coaching agreement.

B. Role of the Client: The Client(s) understand that the Client’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 Client(s)’ ability, 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 Client(s): The Client(s) understand that Coaching is a collaborative process in which the Coach and the Client(s) work together to co-create the Client(s)’ visioning and implementation of goals.


A. Appointments: Appointments with the Coach shall be scheduled at the request of the Client(s) by phone or electronic calendar. Standard appointments are 60 minutes in length, and the Client(s) may request additional coaching over the telephone or by email.

B. Communication: The Client(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: All communication between the Coach and Client(s) is confidential. Any sharing of information between the Coach and any other party requires an authorization form signed by the Client(s) giving written permission for a release of information.

D. Cancelled or missed appointments: Client(s) shall pay in full for any cancelled or missed appointments unless 24-hour cancellation notice is given. Clients are not charged for appointments missed due to a weather emergency.

E. Termination: The Client(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, lack of payment for services


Client(s) shall pay for appointments at the time of service. Alternative arrangements may be made at the request of the Client(s). The fee for an individual appointment is $175.00 and $125 per person when two clients 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.


Client(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