General Information

The coaching relationship is unique in that it is highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding of how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

Description of Coaching

Coaching is a 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 and development of personal goals and to develop and carry out a strategy/plan for achieving those goals.

Coach-Client Relationship

A. The 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.

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

C. The 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. The 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 the 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 create the time and energy to participate fully in the program.

F. The client understands that although Taylor Chambers is a Marriage and Family Therapist, he is not using his license for the services rendered, he is not presenting himself as a therapist to the client, and he is not providing psychotherapy to the client.

The Coaching Process

You have taken a very positive step by deciding to seek coaching. The outcome of your coaching depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. I cannot promise that your behavior or circumstance will change. I can promise to support you and do my very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.

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 the 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.

Appointments

The time of the coaching meetings will be determined by the coach and client based on a mutually agreed upon time. The meetings will be online videos unless otherwise agreed.

Cancellations

Please remember to cancel or reschedule 24 hours in advance. Missed appointments will not be made up.

The standard meeting time for a coaching session is 45 minutes.

Cancellations and rescheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

Phone Accessibility

If you need to contact me between sessions, please email me. I am often not immediately available; however, I will attempt to return your message within 24 hours. Please note that video sessions are highly preferable to phone sessions. However, in the event that you are out of town, sick, or need additional support, phone sessions are available. If a true emergency situation arises, please call 911 or any local emergency room.

Social Media

Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

Electronic Communication

I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all of your treatment, you need to understand that: (1) You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. (2) All existing confidentiality protections are equally applicable. (3) Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee. (4) Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent. (5) There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs.

Minors

If you are a minor, your parents may be legally entitled to some information about your coaching. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

Termination

Either the client or the coach may terminate this Agreement at any time with one week written notice. The client agrees to compensate the coach for all coaching services rendered through and including the effective date of termination of the coaching relationship.

CONSENT FOR VIRTUAL CONSULTATION

1. I understand that my coach wishes me to engage in a virtual consultation.

2. My coach explained to me how the video conferencing technology that will be used to affect such a consultation will not be the same as a direct client/health care provider visit due to the fact that I will not be in the same room as my provider.

3. I understand that a virtual consultation has potential benefits including easier access to care and the convenience of meeting from a location of my choosing.

4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my coach or I can discontinue the virtual consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

Consent to video conferencing services

Various video conferencing services may be used to conduct appointments. By signing this document, I acknowledge:

1. These services are NOT an emergency service and in the event of an emergency, I will use a phone to call 911.

2. Though my provider and I may be in direct, virtual contact, these services do not provide any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.

3. The video conferencing services facilitate videoconferencing and are not responsible for the delivery of any healthcare, medical advice, or care.

4. I do not assume that my provider has access to any or all of the technical information in any particular video conferencing service – or that such information is current, accurate, or up-to-date. I will not rely on my coach to have any of this information.

5. To maintain confidentiality, I will not share my video appointment link with anyone unauthorized to attend the appointment.

By signing this form, I certify:

• That I have read or had this form read and/or had this form explained to me.

• That I fully understand its contents including the risks and benefits of the procedure(s).

• That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.

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.

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.

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 30 days after the notice is 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.

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.

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.

Binding Effect

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

BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.