CONSENT TO TREAT

Consent to Treat (23/9/22)

"Life Coaching is the process of helping people identify and achieve personal gaols through developing skills and attitudes that lead to self- empowerment." - Wikipedia

“Recovery Coaching is a form of strengths-based support for people with addiction or in recovery from alcohol, other drugs, codependency, or other addictive behaviors.” - Wikipedia

Coaching varies depending on the personalities of the clinician and patient and the particular concerns you bring forward. There are different methods we may use to deal with the issues that you wish to address. Coaching calls for an active effort on your part and you must be willing to work on things we talk about both during our sessions and at home. Our first session will involve an evaluation of your needs. At that time, your coach will be able to offer you some impressions of what our work will include, and a plan to follow if you decide to continue with the coaching process. You should evaluate this information along with your own opinions of whether you feel comfortable working with your coach. Coaching is not therapy or treatment.

Appointments are available by phone and remote platforms. Although session frequency may vary, coaching sessions are 50 minutes in length. Frequency will depend on treatment goals and your needs.

Cancellation policy. Any appointments cancelled with less than 24 hours notice will be charged. This form must be completed by the time of your first appointment and kept up to date. If unusual, exceptional circumstances occur, we will make every attempt to work with you on an instance-by-instance basis.

Session Fees. We accept Zelle and credit card payment at or before the time of service. Checks are acceptable for monthly payments mailed prior to your sessions. Session fees are set at the prevailing rate at the time coaching begins. We do not coach minors under the age of 18 currently.

Confidentiality. Information disclosed in session is confidential and will not be revealed without your prior written consent, except where disclosure is required by law. Those exceptions include any disclosure of child abuse, elder/dependent abuse, intent to harm yourself or others or if ordered by the court to provide testimony.

Communication. Voicemail is always available and is generally returned the same business day. Voicemails left after business hours may be returned the following business day. If you feel that you cannot wait for a return call, contact your family physician, the nearest emergency room and ask for the psychologist or psychiatrist or dial 911. When your coach is unavailable for an extended period of time, she will leave the name of a colleague to contact in the event of an emergency.

Your signature below indicates that you consent to treatment and that you have read the information in this document and agreed to abide by its terms during our coaching relationship.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.