Coach Client/Agreement Client Name * First Name Last Name Email * Phone * (###) ### #### Referred By: Coaching Protocol: *Client and coach agree on schedule times of coaching. Sessions will be 45 minutes. *All coaching fees are required in advance *Rescheduling of appointments must be done with 24 hours notice *All meetings will be conducted via Zoom, Facetime or phone 1. As a client I understand that I am fully responsible for my well being during coaching calls, including my choices and decisions. I recognize that coaching is not therapy or any form of medical treatment, and that professional referrals will be given if needed. 2. I understand that “health coaching” or “wellness coaching” is a relationship I have with my coach that is designed to facilitate the creation/development of personal health and lifestyle goals and develop and carry out a strategy/plan for achieving these goals. 3. I understand that health/wellness coaching is a comprehensive process that may involve all areas of my life including health, nutrition, wellness, 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 health and wellness coaching does not treat mental disorders as described by the American Psychiatric Association. I understand the health and wellness coaching is not a substitute for counseling, psychotherapy, mental heath care, or substance abuse treatment, and I will not use it in place of any form of therapy. 5. I understand that information shared during coaching sessions will be held as confidential unless I state otherwise, in writing, as required by law. 6. I understand that health and wellness coaching is not to be used in lieu of professional medical advice. 7. As the client, I agree that it is necessary for me to be an active participant in the coaching process for it to be successful. If I am resistant to making a change, and continue to do the things I have always done, I will get the same results I have always received. I have read and agreed to the above: * Thank you! Client Assessment Form Name * First Name Last Name Name You Wish To Be Called Phone * (###) ### #### Email * Occupation Birthdate MM DD YYYY Preferred form of contact * Phone Email Text Preferred method of session * Zoom Facetime Phone Call The main things I would like to change or improve with my health are: (examples: lose, maintain, gain weight, eat healthier, improve exercise, deal with stress, sleep issues, energy levels, improve chronic health issues-diabetes, high blood pressure, food allergies and insensitivities, gut health. Develop mediation and mindfulness skills, finding more gratitude and joy in life…) Briefly describe your current health lifestyle: Nutrition * Exercise/fitness * Stress * Sleep and energy level * What brings you happiness and joy? * Please add any additional notes to let me know how I can best assist you: Thank you!
