I , agree by my signature below, that I acknowledge the following and would like to initiate health coaching.

• I affirm that I am at least 18 years of age or older.
• I understand that my participation is voluntary and I may withdraw at any time by notifying my coach via phone or email.
• I am aware that I will receive health coaching from a National Board Certified Health and Wellness Coach with a focus in Functional Medicine.
• I am aware that the initial coaching session is a 15 min introduction, foundation session is 45 min, and follow up sessions are 45 min.
• I am aware that each session after the initial session is $60.00 per 45 min.
• I am aware that health coaching will take place at Beyond Mental Health or tele-health.
• I understand that I am expected to make all calls on time and will contact my coach at least 24 hours in advance if an unavoidable conflict arises.
• I am aware that there is a $30.00 no call/no show fee.
I am aware that coaches are not healthcare providers and coaching does not replace seeing a licensed physician.
• I understand that this coaching relationship is in no way to be considered or construed as psychological counseling or any type of therapy or medical intervention.
• I understand that coaching is its own unique process that draws upon strategies for goal attainment and my health coach will guide me towards reaching my health and wellness goals.
• I am aware that coaching results cannot be guaranteed.
• I affirm that I am fully responsible for the choices and decisions in my life and am responsible for my own results.
• I agree that it is my responsibility to tell my coach what works and what does not work, and to be honest about how I would like to be coached.
• I understand that the coach may release me from coaching for any reason, including but not limited to, inappropriate conduct of my doing.
• I agree to hold the coach free of liability and responsibility for any actions or results for adverse situations created as a direct or indirect result or specific referral or advice given by the coach.

This agreement my be extended or terminated by mutual agreement. The coaching services provided to me will include supportive, comprehensive process for attaining health and well-being goals. Topics that I may choose to talk about include nutrition/diet, exercise, sleep, stress management, time management, work goals, relationship goals, finding meaning/purpose, and health challenges.

As a client, I understand and agree that I am fully responsible for my well-being during my coaching sessions, including my choices and decisions.

CONFIDENTIALITY: As a matter of ethics, my coach, by signing below, affirms that she will maintain strict confidentiality about all information shared by me. The only exception is if my coach has reasonable cause to believe there are threats of serious harm to myself or others. My coach is then obliged to report the situation to the proper agent.

Our signatures on this agreement demonstrate the intent to fulfill the intentions and requests above and reflect a complete understanding of the services provided.