Informed Consent Details
GENERAL INFORMATION
The coaching relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding of how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
COACHING PROCESS
You have taken a very positive step by deciding to seek coaching. The outcome depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeat patterns, as well as to help you clarify what it is that you want for yourself.
A. Coach agrees to maintain the ethics and standards of behavior established by the International Coach Federation ("ICF"). It is recommended that the Client review the ICF Code of Ethics and the applicable standards of behavior.
B. Client is solely responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results arising out of or resulting from the coaching relationship and his/her coaching calls and interactions with the Coach. As such, the Client agrees that the Coach is not and will not be liable or responsible for any actions or inaction, or for any direct or indirect result of any services provided by the Coach. The client understands coaching is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease.
C. Client further acknowledges that he/she may terminate or discontinue the coaching relationship at any time, understanding that there are no refunds for unused sessions.
D. Client acknowledges that coaching is a comprehensive process that may involve different areas of his or her life, including work, faith, finances, health, relationships, education, and recreation. The Client agrees that deciding how to handle these issues, incorporating coaching principles into those areas, and implementing choices is exclusively the Client’s responsibility.
E. Client acknowledges that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals, and that it is the Client’s exclusive responsibility to seek such independent professional guidance as needed. If the Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider of the nature and extent of the coaching relationship agreed upon by the Client and the Coach.
F. The Client understands that in order to enhance the coaching relationship, the Client agrees to communicate honestly, be open to feedback and assistance, and to create the time and energy to participate fully in the program.
REQUIREMENTS OF EQUINE-ASSISTED SESSIONS
Clients are advised to wear hard-soled shoes and pants in and around the stables and while working with or riding horses, so as to help prevent horse-related injuries. Open-toe shoes are not allowed in the stable area in the fields, or on horseback. From time to time, you may have the opportunity to experience mounted work. If so, the Client agrees to use an ASTM-SEI Equestrian-approved helmet, which is required while mounted.
CONFIDENTIALITY & PRIVACY
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
• If a client threatens or attempts to commit suicide or otherwise conducts him/herself in a manner in which there is a substantial risk of incurring serious bodily harm.
• If a client threatens grave bodily harm or death to another person.
• If the coach has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
• Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
• Suspected neglect of the parties named in items #3 and # 4.
• If a court of law issues a legitimate subpoena for information stated on the subpoena.
• If a client is in coaching or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best care for you. Information about you may be shared in this context without using your name.
If we see each other accidentally outside of the coaching session, I will not acknowledge you first.
Your right to privacy and confidentiality is of the utmost importance to me, and I do not wish to jeopardize your privacy. However, if you acknowledge me first, I will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the coaching session.
SCHEDULE & FEES
This coaching agreement is valid as of the date this form is submitted. The fee is paid in advance and/or according to the payment plan based on the package selected. The calls/sessions shall be determined by the package. If rates change before this agreement has been signed and dated, the prevailing rates will apply.
REFUND & CANCELLATIONS
There are no refunds. Missed sessions will count as used sessions. Session must be used within 6 months from signing this agreement. Appointments may be rescheduled 24 hours in advance of the appointment for any reason.
RELEASE OF INFORMATION
The Coach engages in training and continuing education pursuing and/or maintaining Coaching Credentials. That process requires the names and contact information of all Clients for possible verification by coaching certification bodies. By signing this agreement, you agree to have only your name, contact information and start and end dates of coaching shared with staff members and/or other parties involved in this process for the sole and necessary purpose of verifying the coaching relationship; no personal notes will be shared.
LIMITED LIABILITY
Except as expressly provided in this Agreement, the Coach makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the coaching services negotiated, agreed upon and rendered. In no event shall the Coach be liable to the Client for any indirect, consequential or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to the Coach under this Agreement for all coaching services rendered through and including the termination date.
ENTIRE AGREEMENT
This document reflects the entire agreement between the Coach and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented except in writing signed by both the Coach and the Client.
DISPUTE RESOLUTION
If a dispute arises out of this Agreement that cannot be resolved by mutual consent, the Client and Coach agree to attempt to mediate in good faith for up to 30 days after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.
SEVERABILITY
If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
WAIVER
The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.
APPLICABLE LAW
This Agreement shall be governed and construed in accordance with the laws of the State of Pennsylvania without giving effect to any conflicts of laws provisions.