• 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.

    CONSENT AGREEMENT FOR COUPLES COACHING

    The coach and the Client(s) enter into this contract voluntarily

    1. THE COACHING PROCESS

    A. Role of the Coach: The Client(s) understand the Coach’s role is to facilitate conversations which promote relationship growth in five primary areas: conflict repair, accepting differences, interpersonal communication skill building, shared visioning and self-care. The Coach will listen carefully, ask key questions, facilitate learning and give insightful feedback that promotes successful creation and implementation of visioning strategies and relationship 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.

    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.

    2. POLICIES

    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 typically respond within 24 hours during 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.

    3. FEES

    Client(s) shall pay for appointments at the time of service. Alternative arrangements may be made at the request of the Client(s). Fees for appointments are $150 per hour for individual sessions and $180 per hour for couples or group sessions. Fees for time spent in telephone or email conversations are billable at the same hourly rate.

    4. DISCLOSURE

    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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