COACHING ZONE B

*MUST READ BEFORE STARTING SERVICES* Life Coaching Zone: Informed Consent

Life Coaching Informed Consent

Cortnie Baity, Ph.D.

baitymft@gmail.com

 

 

Services provided via video chat, phone, text, or email

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.

1) Coach-Client Relationship

A. 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.

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

time.

C. 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.

D. 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.

E. 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.

F. The Client understands that although Cortnie Baity, Ph.D. is a Registered Marriage and Family

Therapist-I (IMT 2554) she is NOT using her license for the services rendered, she is not presenting

herself as a therapist to the Client, and she is not providing psychotherapy to the Client.

1) Services

The parties agree to engage in a Coaching Program through video chat, phone, email, or text meetings.

2) Schedule and Fees

The fee is:

$25 USD per voice messaging session (3 questions/3 responses)

Payment is due via Paypal before the start of each session. Payable to baitymft@gmail.com

3) Procedure

The time of the coaching meetings and/or location will be determined by Coach and Client based on a

mutually agreed upon time. The Coach will initiate all scheduled called and will contact the client promptly at the time of the scheduled appointment. If the Coach will be at any other number for a scheduled call, Client will be notified prior to the scheduled appointment time.

4) 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 by the principles of confidentiality. However, please be

aware that the Coach-Client relationship is not considered a legally confidential relationship (like the

medical and legal professions) and thus communications are not subject to the protection of any legally

recognized privilege. 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: (a) was in the Coach’s possession prior to its

being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Coach from a third party, without breach of any obligation to the Client; (d) is independently developed by the Coach without use of or reference to the Client’s confidential information; or (e) the Coach is required by statute, lawfully issued subpoena, or by court order to disclose; (f) is disclosed to the Coach and as a result of such disclosure the Coach reasonably believes there to be an imminent or likely risk of danger or harm to the Client or others; and (g) involves illegal activity. The Client also acknowledges his or her continuing obligation to raise any confidentiality questions or concerns with the Coach in a timely manner.

5) Cancellation Policy

Client agrees that it is the Client’s responsibility to notify the Coach 24 hours in advance of the scheduled calls/meetings. Coach reserves the right to bill Client for a missed meeting. Coach will attempt in good faith to reschedule the missed meeting.

6) Record Retention Policy (Optional, if the Coach as adopted such a policy)

In order to assure the Client’s confidentiality, the Coach agrees to keep no written progress notes for

sessions unless: (a) the Coach reasonably believes there to be an imminent or likely risk of danger or

harm to the Client or others, (b) the Coach is informed of abuse of a child or dependant adult, (c) the

Coach is informed of sexual contact between a minor and an adult.

7) Termination

Either the Client or the Coach may terminate this Agreement at any time within one week written notice.

Client agrees to compensate the Coach for all coaching services rendered through and including the

effective date of termination of the coaching relationship.

8) 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.

9) 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.

10) 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 (certain amount of time such as 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.

11) 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.

12) 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.

13) Applicable Law

This Agreement shall be governed and construed in accordance with the laws of the State of Florida

without giving effect to any conflicts of laws provisions.

14) Binding Effect

This Agreement shall be binding upon the parties hereto and their respective successors and permissible

assigns.

BY PAYING FOR SERVICES YOU ARE AGREEING TO THE TERMS OF THIS CONTRACT

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