Please read this form and bring it to our first meeting. We will go over the terms and conditions together and then you can sign the form.
Please print this page or download the form for printing later:
Prior to beginning a life coaching relationship with me, please read the following agreement and indicate your understanding by signing below:
- I understand that life coaching is a relationship I have with a life coach and that it is designed to facilitate the establishment of long-range and short-range goals and the achievement of those goals.
- I understand that life coaching is for people who are already well-adjusted and emotionally healthy.
- I understand that confidentiality in the life coaching relationship is limited. Confidentiality may not apply to certain crimes that have been committed or to certain crimes that are being planned. Some crimes may need to be reported to legal authorities. It is also possible that certain topics could be reviewed with other life coaching professionals for training and development purposes.
- I understand that life coaching does not treat mental disorders as defined in the DSM. If I have anything in my past indicating that I have an unresolved and serious emotional or physical problem, or a mental disorder, then I certify that I am not using life coaching as a substitute for assistance from a mental health professional and/or a medical doctor.
- I will not use life coaching as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment. I realize that Maryasha Katz is not providing any of the above to me.
- I will not use life coaching in lieu of professional medical advice, legal counsel, accounting assistance, or business consultation, and for each of these areas I should consult the appropriate professionals. I further acknowledge that all decisions on dealing with these issues lies exclusively with me.
- I understand that if I am unable to attend an appointment, it is my responsibility to cancel my session at least twenty-four hours in advance of the session. Failure to do so will result in my being fully charged for the session. Refunds will not be given if I have already paid for the service. Certain exceptions will be made to this policy in the event of emergencies at Ms. Katz’ discretion. Cancellation notice should be left on Ms. Katz’ voice mail at (831) 234-5813. I understand that payment for services are due before services are rendered.
- Some sessions may use video conferencing such as Skype. In the event of technology glitches that are not quickly smoothed out, I understand that the session may be continued by telephone.