Name *

First Name

Last Name

Phone Number *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

MM

DD

YYYY

Significant Other's Name (if applicable)

First Name

Last Name

Agreement Terms: • Client calls the coach at the scheduled time • Client pays coaching fees in advance 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. 6. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law. 7. 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. 8. I understand that coaching is a partnership and I get out of it whatever I put into it. The coach is responsible for owning the process, and I, as the client, am responsible for owning the agenda. With that said, I will come to each session ready to work. Having reflected on what I stated that is important to me as a goal or otherwise and how I hope to progress. I have read and agree to the above. By checking the box and typing your name you agree to the above terms of this agreement. *

Agreement Terms: • Client calls the coach at the scheduled time • Client pays coaching fees in advance 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. 6. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law. 7. 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. 8. I understand that coaching is a partnership and I get out of it whatever I put into it. The coach is responsible for owning the process, and I, as the client, am responsible for owning the agenda. With that said, I will come to each session ready to work. Having reflected on what I stated that is important to me as a goal or otherwise and how I hope to progress. I have read and agree to the above. By checking the box and typing your name you agree to the above terms of this agreement.

Agree