Collaborative Neutral Family Consent Agreement

Collaborative Neutral Family Coach 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 Collaborative Neutral Family Coach (Coach) and the Parent(s) enter into this contract voluntarily.


A. Role of the Family Coach: The Parties understand that the Coach’s role is to facilitate the process of reaching a settlement agreement as efficiently and productively as possible, while preserving the dignity and emotional well-being of each Party. It is the intent of the Coach to minimize the impact of the divorce on the children and create the most positive outcomes for both Parties. The Coach will create a neutral setting in which both parties con- tribute to agreements regarding each issue in the Collaborative divorce process. Addition- ally, the Coach will work with the parties to address parenting issues.

The Coach is not authorized to give legal advice and will communicate with attorneys as necessary to avoid interfering in any legal process. The Coach is not serving in the role of a therapist. If the Coach determines that psycho therapeutic interventions would be helpful for the Parent(s), the Coach will make a referral to an appropriate therapist.

B. Role of the Parties: The Parties understand that the their 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 his/her 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 Parties: The Parties understand that Coaching is a collaborative process in which the Coach and the Parties work together to co-create the Par- ties’ goals for the divorce, for parenting, for communication, for self-care and for the coaching process. Collaboration may take place between the Coach and each Party separately or with the Parties together.


A. Appointments: Appointments with the Coach shall be scheduled at the request of the Parties by phone, by email or in person. Coaching sessions may take place in person or over the telephone. Standard appointments are 60 minutes in length, and the Parties may re- quest additional coaching over the telephone or by email.

B. Communication: The Parties may contact the Coach by telephone, email or text mes- sage. The Coach will respond within 24 hours.

C. Confidentiality: All communication between the Coach and Parties is confidential and may not be used in any Court proceeding. Any sharing of information between the Coach and any other party requires an authorization form signed by the Party giving written permission for a release of information. Either party 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 Parties 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 Parties shall pay in full for any cancelled or missed appointments unless 24-hour cancellation notice is given.


Parties shall pay for appointments at the time of service. Alternative arrangements may be made at the request of the Parties. Fees for all appointments and meetings are $180.00 per hour. Fees for additional time spent in telephone or email conversations are billable at $180.00 per hour, calculated at 15-minute intervals. The Coach will notify the Parties before any charges are accumulated for telephone or email conversations. The Coach shall bill the Parties monthly with an itemized statement for telephone and email coaching.


Parties 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