Please complete this form to request your reservation.
**By sending this form you agree to the following statements:
1) I understand that coaching does not involve the diagnosis or treatment of disorders as defined by the American Psychiatric Association. I understand that the coaching services I will be receiving from my Coach are not offered as a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that my Coach is not acting as a mental health counselor or a medical professional.
2) As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time.
3) I understand that “coaching” is a professional-client relationship I have with my coach that is designed to facilitate the creation/ development of personal, professional or financial goals and to develop and carry out a strategy/plan for achieving those goals.
4) I understand that my Coach will protect my information as confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken and my confidentiality agreement limited in this capacity. Furthermore, if my Coach is ordered by a court to provide information or to testify, they will do so to the extent of what the law requires.
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or call us 613 – 930-5152