Coaching Agreement & Informed Consent
Love Therapy Center
San Francisco & San Diego
(415) 412-6615
(619) 376-5576
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Description of Coaching
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.
đź“… This Agreement is entered into by and between Love Therapy Center. Select your Coach:

Select your Coach
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Your First Name *
Last Name *
What fee did you discuss with your Coach?  $ *
Type of Coaching:
Indicate which type(s) of Coaching:
(Select as many as apply)
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Required
Coaching Outcomes & Goals:
Indicate which type(s) of Coaching:
(Select as many as apply)
Coach-Client Relationship
A. 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.

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. 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.

D. 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.

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 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.
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Date of Birth
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MM
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DD
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YYYY
Address *
Phone Number *
OK to leave messages?
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OK to text on cell?
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Phone (Work)
OK to leave messages at work?
Clear selection
Email Address *
Phone (other)
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OK to leave messages at home?
Clear selection
Employer / School
Emergency Contact Name
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Emergency Contact Phone
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Relevant Medical Conditions
History, Current Condition, Changes in Condition

Medications
TELEPHONE & EMERGENCY PROCEDURES
If you need to contact us between sessions, please email or leave a message on the number your Coach has provided.   Your message will be returned as soon as possible. If it is a brief consult or appointment change, there is no charge.Telephone & Video sessions are charged at same rate as in person. Calls are typically returned within 24 - 48 hours, except weekends or vacations. 

Be aware that mobile communication can be accessed by unauthorized parties. Please use the email address if you prefer another method of contact.

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Required
PAYMENTS & CANCELLATIONS

Clients are expected to pay the agreed-upon fee no later than the end of each session unless previous arrangements have been made. We suggest paying prior to the session to avoid taking time during the session for payment. Session fees not paid within 24 hours will incur a $20 late fee unless prior arrangements have been made.

Your fee will be determined with your Coach and may vary depending on the Coach, package, or promotion. We accept credit card, Zelle, Venmo, cash, or checks. Remote sessions, extended sessions, or other services will be charged at the same rate unless noted otherwise in advance.

Please provide 48 hours’ notice for cancellations. Missed appointments with less than 48 hours’ notice may be charged. If you encounter issues paying on time, please notify us as early as possible.

If you request, we can provide a receipt (Superbill) on a monthly basis, but note that coaching is not reimbursable by insurance and does not constitute mental health treatment.

Tax Deductibility Disclaimer

Coaching services provided by Love Therapy Center are intended for personal and/or professional development. While not medical in nature and therefore not eligible for health insurance reimbursement, coaching services that directly support your business, career advancement, or professional development may be considered a tax-deductible expense.

It is your responsibility to consult with your tax advisor or accountant to determine the deductibility of coaching fees based on your specific situation.

Love Therapy Center does not provide tax advice and makes no guarantees regarding deductibility.

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Required
CONFIDENTIALITY

Information shared during coaching sessions and related documents is held in confidence unless written permission is given to release it, except under these circumstances:

Internal case consultation within Love Therapy Center for quality improvement.

Mandated reporting of suspected abuse or neglect of a child, dependent adult, or developmentally disabled person.

If there is a risk of harm to yourself or others, we are legally obligated to act to prevent harm.

If served with a lawful subpoena or court order.

If your information presents a risk to the safety of Love Therapy Center staff.

In a medical emergency, emergency personnel may receive limited necessary information.

If a formal complaint is filed against Love Therapy Center.

If you are at imminent risk of self-harm. 

LEGAL PROCESS

Coaching is a confidential process, but not a legally privileged one. If you are involved in legal matters, such as divorce or custody, we cannot guarantee the confidentiality of coaching content if records are subpoenaed. We do not participate in legal proceedings on behalf of clients.

RECORDS + SUPERVISION

Love Therapy Center may consult other professionals or supervisors. These conversations will never include identifying details unless required for training or certification purposes, in which case only your name and dates of engagement may be shared.

Coaching records may be maintained digitally. You may request to view your records unless doing so would cause harm, as determined at our discretion.

EMERGENCIES

In the event of an emergency or concern for your safety or the safety of others, we will act to protect all parties. This may include contacting your emergency contact. For urgent situations, please call 911.

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Required
NO SECRETS POLICY FOR COUPLES / FAMILIES

In couples or family coaching, the entire group is considered the coaching client. Confidentiality does not apply individually. Information shared in individual sessions may be disclosed to the group if necessary for ethical or effective coaching.

If a topic must remain private, you may wish to work separately with an individual coach.

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Required

 COACHING PROCESS + LENGTH

Coaching offers insight, growth, and practical change but is not a substitute for therapy. Progress varies for each client. A commitment to your goals and consistent engagement (often weekly in early stages) is recommended.

Coaching may be concluded by either the Client or the Coach at any time. Ideally, termination is a collaborative process. As part of our work together, we will regularly evaluate progress and alignment with your goals. When it feels appropriate to begin concluding the coaching process, we may gradually space out sessions — for example, shifting to every 2 weeks, then 4 or 8 weeks or on an as-needed basis — to support your integration and autonomy.

This titration phase allows time to reflect, assess any remaining needs, and ensure meaningful closure. In some cases, the Coach may recommend pausing or ending the coaching relationship if it is no longer in alignment, if a different support is indicated, or if terms of the agreement are not being upheld. Any such recommendations will be made with transparency and in support of your growth.


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