NameNumber of Sessions Per MonthSession DaySession TimeCoaching Start DateCost of SessionTo my client: Please review, adjust, sign where indicated, and return to me by email or fax. Ground Rules: 1. Clients are called by coach at the scheduled time. 2. Client pays coaching fees in advance. 1. As a client, I understand and agree that I am fully responsible for my well-being during my coaching calls, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time. I recognize that coaching is not psychotherapy and that professional referrals will be given if needed. 2. I understand that "life coaching" is a relationship I have with my coach that is designed to facilitate the creation/development of personal, professional, or business goals and to develop and carry out a strategy/plan for achieving these goals. 3. I understand that life coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education, and recreation. I acknowledge that deciding how to handle these issues and implement my choices is exclusively my responsibility. 4. I understand that life coaching does not treat mental disorders as defined by the American Psychiatric Association. I understand that life coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment and I will not use it in place of any form of therapy. 5. I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with this person regarding the advisability of working with a life coach and that this person is aware of my decision to proceed with the life coaching relationship. 6. I understand that information will be held as confidential unless I state otherwise, in writing, except required by law. 7. I understand that certain topics may be anonymously shared with other life-coaching professionals for training or consultation purposes. 8. I understand that life coaching is not to be used in lieu of professional advice. I will seek professional guidance for legal, medical, financial, business, spiritual, or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my responsibility. I have read and agree to the above. Client signature _________________________ Date _______________Submit