1. Coach agrees to maintain the ethics and standards of behavior set by the International Coach Federation “(ICF)”.
   
   
2. Client is responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results. As such, the Client agrees that the Coach is not and will not be liable 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.
   
   
3. Client understands that coaching is not to be used as a substitute for professional advice by legal, mental, medical, financial or other qualified professionals and will seek independent professional guidance for such matters. If Client is currently under the care of a mental health professional, Coach will recommend that Client inform the mental health care provider.
   
   
4. Client agrees to communicate honestly, be open to feedback and assistance and create the time and energy to participate fully in the program.
   

SERVICES: The parties agree to engage in a ((**Package**)) Coaching Program via zoom meetings. In-person is available upon request. Additional fees may apply. Coach will be available to Client by phone, e-mail and text in between scheduled sessions as defined by the Coach. If there is an issue you would like to discuss, you may reach out at anytime.

However, calls should go no longer then 10-15 minutes. If you need to spend more time, client may schedule as many sessions as needed. Coach may also be available for additional time, per client’s request on a prorated basis rate of ((**RATE**)) an hour (for example, reviewing documents, reading or writing reports, engaging in other client related
services outside of coaching hours).

SCHEDULE & FEES: This coaching agreement is valid as of the date of purchase. The fee is ((**TOTAL COST**)) For ((**ELI ASSESSMENT**)) and a package of ((**sessions)).

The sessions are normally 60 minutes in length, but additional time is available upon request. If rates change before this agreement has been signed and dated, the prevailing rates will apply.

PROCEDURE: The time of the coaching sessions and/or location will be determined by Coach and Client based on a mutually agreed upon time. The Client agrees to be on time and prepared for all sessions.

CONFIDENTIALITY: This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Coach as part of this relationship, is bound to confidentiality by the ICF Code of Ethics but is not considered a legally confidential relationship (like in Medicine or Law). The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent. Confidential information does not include information that:

• Was in the Coach’s possession prior to its being furnished by the Client
• Is generally known to the public or in the Client’s industry
• Is obtained by the Coach from a third party, without breach of any obligation to the Client
• Is independently developed by the Coach without use of or reference to the Client’s confidential information
• That the Coach is required by law to disclose
• If the Coach has reason to believe the Client may hurt themselves or others or if Coach has reason to believe the Client is unwell.
  

CANCELLATION POLICY: Client agrees that it is the Client's responsibility to reschedule his or her own session and notify the Coach 24 hours in advance. Failure to do so will result in the loss of the session and client will be financially responsible for the time.

TERMINATION: Either the Client or the Coach may terminate this agreement at any time with 1 week written notice.

LIMITED LIABILITY: Except as expressly provided in this agreement, the Coach makes no guarantees or warranties, express or implied. In no event will the Coach be liable to the Client for 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, will be limited to the amount paid by the Client to the Coach under this agreement for all services rendered up until the termination date.

This is the entire agreement of the parties, and reflects a complete understanding of the parties with respect to the subject matter. This agreement supersedes all prior written and oral representations.

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 (certain amount of time such as 30 days) after notice given. If the dispute is not 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.

AUTHORIZATION FOR TESTIMONIAL USE

What is being disclosed?

• I understand this authorization covers all photographic or video images of the Client and/or any written or electronically submitted testimonials pertaining to the Practice (herein collectively referred to as the “Information”); and
• grants the right to the Practice to reproduce, use, and disclose the Information, with or without the Client’s name or other personally identifiable information; and
• to publicize the fact that coaching services were provided to the client by the Practice

Who is disclosing it?

This authorization to disclose is given to the Practice listed above and, by extension, its employees, contractors, and/or Business Associates (according to their Business Associate Agreement)

Who is receiving it?

I understand this authorizes disclosures of the Information to contractors and/or Business Associates of the Practice and subsequently any persons, without limitation, who may view the information in printed or digital form in promotional materials including social media or internet sites

Why is it being disclosed?

The purpose of this authorization is to permit the Information to be used for marketing of the Practice, and I explicitly consent to the use of the Information for advertising and marketing activities to promote the Practice. I acknowledge and agree that no compensation will be provided in exchange for the use of the Information

How long is this authorization good for?

This authorization remains valid during two years from the day it was signed, unless effectively revoked in writing by the Client before that date or event

Right to revoke:

I understand that I, as the Client (or parent/legal guardian of the Patient) may revoke this authorization at any time by notifying the Practice by Certified Mail, return receipt requested, but that revocation will only affect uses and disclosures initiated after the date notice is received by the Practice and will not apply to the extent that the Practice has previously acted in reliance on the authorization. Upon receipt of the notice of revocation, the Practice will make reasonable efforts to remove protected health information from social media platforms over which it has control, but cannot guarantee full removal. I understand that protected health information already used or disclosed prior to any revocation may no longer be protected.

Condition of Treatment:

This authorization is voluntary. I understand that the Practice cannot condition treatment of the Client on whether I sign this authorization, and that my decision not to sign will not influence or affect the Client’s treatment in any way

Subject to redisclosure:

I understand that protected health information once used or disclosed is no longer protected under federal medical privacy law and is subject to redisclosure. I acknowledge that the internet allows for wide sharing and forwarding of information, and that the Practice cannot control all re-disclosure of the Information.

I understand I will be provided a copy (either paper or electronic) of this authorization once signed.