NEW COACHING CLIENT FORMS PACKET

Please save this file to your desktop before continuing. Any changes made to the enclosed forms will be lost if you do not save this file to your computer first. Once you have saved this form, fill in the information where requested. Please note that information that does not appear on your screen in the form field will not print. You are limited to the size of the box. Additional information may be sent separately.

Completed forms must be printed and signed. They must be received prior to the first scheduled coaching session.

Enclosed:

New Coaching Client Welcome and Agreement – Print, sign, and bring to first appointment

Client Intake – Fill in form, email prior to first appointment

Statement of Intent – Print, sign, bring to first appointment

Release of Relevant Treatment Information – Print, sign, bring to first appointment

Confidentiality Agreement – For your records

NEW COACHING CLIENT WELCOME & AGREEMENT

Each new client to my practice is a welcome addition. We have had our introductory call or visit with each other and determined that we are optimistic and enthusiastic about what we can accomplish together. To bring our “best selves” to the coaching relationship, it is important that we share the same understanding about how we will work together.

Basic Shared Agreements:

I recommend a 3-month commitment to 2-4 sessions a month. A 3-month commitment ensures that you understand that it is hard work to change habits of thinking and acting, and that you are committed to making a concentrated effort and understand that it takes time.

Payment for both Coaching Packages and Individual Sessions must be received by the date of the first session in order to begin our coaching relationship. After the initial month of coaching payment must be received by or on the date of the first session of the month for the number of sessions scheduled for that month. ______(initial). You may make payments via Paypal or I can run your card over the phone. Checks are accepted and can be mailed to ___________. Cash is accepted in person.

Each session is 1 hour long and takes place:

___By phone

___Face to Face

___By video chat via Google+, Skype, WhatsAPp

I will bring myself to those coaching sessions free from distractions and respectfully request that you do the same. A coaching session in a public venue with distractions and background noise is not efficient.

We agree that we will each show up at the mutually scheduled time for our coaching session and if you have to reschedule you will do so with a minimum of 24 hour notice. I certainly understand that emergencies do arise and will accommodate those on a case-by-case basis. Appointments rescheduled with a notice will not be charged an extra fee.

Should you “no-show”, “no-call” for two appointments during our coaching relationship (without notification or rescheduling) we will evaluate whether or not coaching is appropriate for you right now. A surcharge of $25.00 may be applied for any “no-show”, “no-call” appointments thereafter.

If you’ve purchased a package and find yourself unable to use your sessions for any reason, you may put the remaining sessions on a 3-month hold unless you have purchased a coaching package as a “Special” and then the stipulations of that special purchase apply. Session credits will not be carried out further than 3-months. Coaching fees are non-refundable should you decide to “quit” the process, as our complimentary session is designed to remove the possibility that we would not be a good fit for each other.

I welcome communication between our sessions via email. It is my expectation that you will reach out if you hit a “sticky” spot that you would like some feedback on, and that you will share the successes that you have on the way to creating your desired future. If you need an “emergency call” I can usually accommodate within the same day and I do not bill for calls that are 15 minutes or less.

I welcome your input and questions along the way. Our relationship is a collaborative one, and the more you put into it the more you will get out of it. Ask me questions, challenge my point of view, bring resources to the table that you’ve found, tell me where I’m wrong, and share with me your insights along the way. You are your own best expert even if you don’t know that yet (you will shortly!).

I have made an agreement to ____sessions a month for ____months. I understand that I may renew this agreement at the end of this agreement period. I agree to pay ___________ for the ______month period.

I will be available for my coach’s call at the appointed time. I have read and agree to the working agreements above, and will honor them during our coaching relationship.

Client (Print/Sign)

Date:

Welcome!

CLIENT INTAKE

I am excited to be embarking on this journey with you, and look forward

to getting to know you better over the coming months. It would be helpful to me if

you would complete the following basic information and email it back to me before our first session. Save this form to your desktop before beginning to fill it out, or changes will be lost.

Name:
Street Address:
City/State:
Country:	Zip or Postal code:

Email of Choice:
Phone of Choice:
Fax:

Name of Employer and Position:
Name of Spouse/ Significant Other:
Name and Ages of Children:

Please do a life area satisfaction self-assessment. Ten being perfect, it can’t get any better, one meaning lots of improvement is needed in this area.

Relationships

Friendship:

Family:

Romantic:

Health:

Career:

Happiness:

Fun:

Sense of Purpose

Sense of Peace:

Financial Security:

Other: ______________

What is one thing you would like to achieve that would make the biggest impact in your life? How would this change your life?

What do you want your life to look like in the next two years, personally and professionally?

What do you want that you don’t believe you can make happen? Why?

What are the top four things putting up with in your life?

1:

2:

3:

4:

How would you be different if you no longer had to deal with these things?

What are you committed to doing to change the issues in #5?

What are three key areas of personal development would bring you the most happiness if they were improved?

Area 1:

Area 2:

Area 3:

Write down one thing in your life you would like to have but don’t have a clue how to go about getting it.

10. Assuming all human beings have some way of sabotaging their life, or holding themselves back, what would be your most common method? (Circle your favorites, write in any that are missing)

Not taking chances through fear

Not always telling absolute truth

Behaving the way others want you to behave

Acting as the “Lone Ranger”

Tolerating

Needing to be Right

Not saying “No”

Controlling life/people

Procrastination

Indecision

Following secondary* goals (*i.e. goals that won’t ultimately make me happy)

Other:

STATEMENT OF INTENT

All coaching services delivered by __________, utilizing principles, methods and tools of the _______________ Coaching System, are meant to challenge, uplift, and support you emotionally, mentally, and perhaps even physically and spiritually. However, coaching is not psychotherapy or counseling. If you feel psychologically stressed to the point that it is interfering with your ability to function, please have the courage to seek the help you need in the form of a professional counselor. Life coaching may augment your therapy, but the work of coaching is meant to be done when major emotional and psychological wounds are already healing or healed. In that spirit, please read the following and sign below should you agree to each statement and wish to proceed:

I understand that the life coaching services I will be receiving from ______ are not offered as a substitute for mental health care. I also understand that my coach, __________, is not acting as a psychotherapist, and does not purport to offer mental health care.

I understand that my coach will maintain the confidentiality of our communications to the extent defined by the laws of the states in which each of us resides.

I understand and agree that I am fully responsible for my well-being during my coaching sessions, and subsequently, including my choices and decisions.

I understand that all comments and ideas offered by my coach are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to my coach to assist me in achieving such goals.

I hereby release, waive, acquit and forever discharge ___________ and ___________, their agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of actions, omissions, or commissions taken by myself or by ____________________, as a result of the information given by _________ or otherwise resulting from the coaching relationship contemplated hereunder. I further declare and represent that no promise, inducement or agreement not herein expressed has been made to me to enter into this release. The release made pursuant to this paragraph shall bind my heirs, executors, personal representatives, successors, assigns, and agents.

I have read the statements above and I understand and agree with the points contained therein:

Client Signature and Date

RELEASE OF RELEVANT TREATMENT INFORMATION

In context of my coaching relationship with_________, ___________, I authorize him/her to contact other health care professionals that I am currently working with as it pertains to our coaching relationship.

I am currently in treatment/consulting with the following individuals (e.g., psychotherapist, nutritionist, homeopathic practitioner, psycho-pharmacologist, or any other medical professional):

Name	Contact Information
I am currently on medication (type):
In the past I have been on the following medications (types/duration/date of disuse):

If I am working with a psychotherapist (which I have disclosed above), my practitioner knows that I am working with ____________ and that our work is not therapeutically based. I understand, and agree, that Elizabeth Sabet does not represent herself as anything other than a trained coach.

Agree:	(please initial)	Not Applicable	(please initial)

I understand, that in keeping with the requirements of coach credentialing by the International Coach Federation (www.coachfederation.org) _____________________

will be keeping a confidential record of my name, phone number and email address. This information will be used exclusively for the purposes of meeting those requirements, and following the credentialing process where two assessors will validate my list and subsequently destroy the two copies, only the master list will be maintained within secure files of the ICF.

I,	, am fully disclosing this information and am not withholding information that is pertinent to my coaching.

Signature	Date

CONFIDENTIALITY AGREEMENT

The conversations that we have within our coaching sessions are confidential and will be protected as such. Information will be shared outside of our sessions only with your written consent or in the event that a Court Judge demands it, however, the following are instances where I would be obligated by law to break our confidentiality agreement without your permission:

If it is assessed during your participation in coaching sessions that abuse or neglect of children or elders is occurring.

If in my presence you threaten to kill or harm another individual, and I am convinced that you will act on this threat, or that you may lose control of your actions.

If at any time during the course of our sessions, I determine that you are a danger to yourself, I will inform you of that opinion and make every effort to keep you from endangering your life. In some cases this may include notifying the police or family members.

ENTER NAME OF COACH AND LEGAL BUSINESS NAME HERE