Coaching Agreement and Informed Consent
This document is intended to provide information about Values Intersecting Action (V.I.A.) services. Please read this document carefully and ask your coach any questions you may have about its contents.
About the Coaches
Drs. Alexandra Cowden Hindash, Jerika Norona-Flores, and Tanisha Thelemaque each hold doctoral degrees in clinical psychology. Each coach partners with individuals to set and accomplish attainable life coaching goals.
This agreement is for life coaching and not therapy or counseling. While coaching involves helping you make changes to attain your personal and/or professional goals, life coaching does not address mental disorders as defined by the American Psychiatric Association or the American Psychological Association.
By signing this document, you are agreeing that you understand the differences between life coaching and therapy and will pursue appropriate mental health services if necessary.
Contacting the Coaches
Email contact is welcome at email@example.com or you may leave a message at (707)-385-9770. Please leave your name, phone number, and a brief message concerning the nature of your call. In the event of an emergency, please call 911 or report to an emergency room to request assistance.
Appointments, Cancellation, Termination, and Fees
Life coaching sessions take place through the client’s preferred method (in person, by phone, or video chatting) at a mutually convenient time for the coach and client. Each appointment is 50 minutes long and the typical hourly fee is $75 to $150. If clients purchase a package deal, they are responsible for the advertised price of the package. Payment is due at the start of each session, and there is an added 3% fee when using credit card payments. Insurance coverage is not available for sessions.
Cancellations and requests to reschedule should be made at least 24 hours in advance. If a client does not provide 24-hour advanced notice for a cancellation, the client may be charged a late cancellation fee of $30.00.
The client or coach may terminate coaching services at any time with 1-week written notice. The coach will be compensated for all coaching services rendered through and including the effective date of termination of the coaching relationship.
Your identity, information, and session content is confidential unless there is a professional reason for its disclosure. This means that your coach will not share information about you or what we discuss during coaching sessions. The coach will disclose confidential information without a specific release if it is necessary to prevent foreseeable imminent harm to the client or another person. However, life coaching is not considered a legally confidential relationship and communication in this context is not legally protected. Confidentiality is also limited when sessions are conducted over the phone, online, or in public spaces. The coaching sessions may be monitored or recorded for the protection of the coaches. Clients are encouraged to use their own discretion.
Client Acknowledgement and Release of Liability
The coaches make no guarantees, representations or warranties of any kind or nature, express or implied with respect to the coaching services negotiated, agreed upon and rendered. Your signature indicates that you have read this agreement and understand its contents, and that you hold harmless Values Intersecting Action, GP and your life coach from all liabilities and claims that may result from your participation in life coaching.