Consent & Agreement for Coaching Services

Coaching services will be provided in a manner that maintains client privacy and complies with the rules and guidelines of the California Association for Licensed Professional Clinical Counselors (CALPCC), as well as all applicable state and federal laws.

I understand that these services may include direct face-to-face contact, and/or Virtual services. This means time spent may include reviewing records, consulting and/or coordinating with other professionals.

Yes

I understand that the fee for this therapy will be: $150 per Coaching session. Payment is made via charge/card and is due at the time of service or unless other arrangements have been made in advance.

Yes

I give consent for the following individual(s) to access and handle financial information related to payment for my coaching sessions:

If nona, type 'N/a'

I have reviewed my coaching plan and session frequency, and I understand that this is intended to be a short-term coaching relationship.

(Print your name for Signature)

Date of Signature

YYYY

Consent & Agreement for Coaching Services

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