Life Coaching Agreement
Love Therapy Center, LLC
San Francisco & San Diego
(415) 412-6615
(619) 376-5576
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Coach-Client Relationship
Coaching is partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client in a thought-provoking and creative process that inspires the client to maximize personal and professional potential. It 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.

Coach-Client Relationship
Coach agrees to maintain the ethics and standards of behavior established by the International Coach Federation “(ICF)” (Coachfederation.org/ethics). It is recommended that the Client review the ICF Code of Ethics and the applicable standards of behavior.

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. 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.

Client further acknowledges that he/she may terminate or discontinue the coaching relationship at any time.

Client acknowledges that coaching is a comprehensive process that may involve different areas of his or her life, including work, finances, health, relationships, education and recreation. The Client agrees that deciding how to handle these issues, incorporate coaching principles into those areas and implementing choices is exclusively the Client’s responsibility.

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 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.

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.
First Name *
Last Name *
OK to contact via Email? *
Date of Birth *
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Address *
Phone Number: *
OK to leave messages?
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OK to text on cell? *
Phone (Work) *
OK to leave messages at work? *
Email Address: *
Phone (Home) *
OK to leave messages at home? *
Employer / School
Emergency Contact Name
Emergency Contact Phone:
Relevant Medical Conditions
history, current condition, changes in condition
Medications
Reason for Seeking Coaching? Why now? Please indicate which area(s) do you would like to focus on: Relationship Harmony, Money & Abundance, Career Satisfaction or Decision, Health, Well Being, Personal Growth, Other:
How motivated are you to make a change?
What will happen if you don't change?
Sleeping Patterns
Eating Patterns
Drinking patterns
i.e. alcohol / coffee / soda / water
Other chemical use patterns
i.e. cigarettes, drugs
Please describe these or other areas of concern
What are your goals for coaching? What brings you to coaching now? What are you afraid will happen if you do nothing? What is getting in the way of you achieving your goals?
I have read and understand the information provided above. I have discussed it with my coach, and all of my questions have been answered to my satisfaction. I understand that by entering my name below I am providing my electronic signature. *
Name *
Date *
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