Coaching Consent Form

Effective date: November 1, 2021

 

Megan Rhoads, Psy.D.

2377 Gold Meadow Way, Ste 101

Gold River, CA 95670

(916) 397-0505

[email protected]

 

Services provided via video chat, phone, and email.

Description of Coaching

Coaching is a partnership (described as an alliance, not a legal business partnership), between Coach (Dr. Rhoads) and Client (yourself) in a thought-provoking and creative process that inspires Client to maximize personal and professional potential. It is designed to facilitate the creation and development of personal, professional, or business goals and to develop and carry out a strategy/plan for achieving those goals.

Coach-Client Relationship

A) Client is solely responsible for creating and implementing his/her/their own physical, mental, and emotional well-being, decisions, choices, actions, and results, arising out of, or resulting from, the coaching relationship and his/her/their coaching calls or interactions with Coach. As such, Client agrees Coach is not and will not be held liable or responsible for any actions or inaction, or for any direct or indirect result of any services provided by Coach. Client understands coaching is not therapy and does not substitute therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease. 

B) Client further acknowledges that he/she/they may terminate or discontinue the coaching relationship at any time.

C) Client acknowledges that coaching is a comprehensive process that may involve different areas of his/her/their life work, including: work, finances, health, relationships, recreation, spirituality, and education. Client agrees that deciding how to handle these issues, incorporate coaching principles into those areas, and implementing choices is exclusively Client’s responsibility.

D) Client acknowledges that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical, or other qualified professionals and that it is Client’s exclusive responsibility to seek such independent professional guidance as needed. If Client is currently under the care of a mental health professional, it is recommended that Client properly inform the mental health care provider of the nature and extent of the coaching relationship agreed upon by Client and Coach.

E) Client understands that in order to enhance the coaching relationship, Client agrees to communicate openly and honestly, to be open to feedback and assistance, and to create the time and energy to participate fully in the program.

F) Client understands that, although Dr. Megan Rhoads is a licensed psychologist and therapist (PSY29761), she is not using her license for the services rendered. She is not presenting herself as a therapist to Client, and she is not providing psychotherapy to Client.

Services

Both parties agree to engage in a coaching program:

• By email: [email protected]
• By video chat: (Zoom)  https://us06web.zoom.us/j/7982493166?pwd=SmJaYUIzZ0YyYlE1NE5TdHZPamEvUT09
• By phone: (916) 397-0505

Schedule and Fees

Single Session:                                              $297 USD

4-Session Package:                                      $997 USD

Small Group Sleep Pyramid Program:      $1297 USD

1:1 Sleep Pyramid Program:                      $1997 USD

Payment is due in full at time of booking your first appointment. 

Procedure

 The time of coaching meetings and/or location will be determined by Coach and Client based on a mutually agreed-upon time. Coach will initiate all scheduled calls and will contact Client promptly at the time of the scheduled appointment. If Coach will be at any other number for a scheduled call, Client will be notified prior to the scheduled appointment time. 

Confidentiality

This coaching relationship, as well as all information (documented or verbal) that Client shares with Coach as part of this relationship, is bound by the principles of confidentiality. However, please be aware that the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and thus communications are not subject to the protection of any legally recognized privilege. Coach will not disclose Client’s name as a reference without Client’s consent.

Confidential Information  does not include information that: 

a) was in Coach’s possession prior to its being furnished by Client;

b) is generally known to the public or in Client’s industry;

c) is obtained by Coach from a third party, without break of any obligation to Client;

d) is independently developed by the Coach without us of or reference to Client’s confidential information; or

e) Coach is required by statute, lawfully issued subpoena, or by court order to disclose;

f) is disclosed to Coach and as a result of such disclosure Coach reasonably believes there to be an imminent or likely risk of danger or harm to Client or others; and

g) involved illegal activity.

Client also acknowledges their continuing obligation to raise any confidentiality questions or concerns with Coach in a timely manner.

Cancellation Policy

 Client agrees that it is Client’s responsibility to notify Coach 24 hours in advance of the scheduled calls/meetings. Coach reserves the right to bill Client for a missed meeting (canceled less than 24 hours ahead of meeting start time). Coach will attempt in good faith to reschedule the missed meeting. 

Record Retention Policy

In order to assure Client’s confidentiality and cohesiveness care, Coach agrees to keep written progress notes for coaching sessions in the secured Kajabi database. Points of information in the progress notes include:

• topics discussed
• progress made
• action items
• information pertaining to if/when Coach reasonably believes there to be an imminent or likely risk of danger or harm to Client or others,
• information pertaining to if/when Coach is informed of abuse of a child or dependent adult, or
• information pertaining to if/when Coach is informed of sexual contact between a minor and an adult

Additionally, records will be maintained for 3 years after termination of services, at which time, they will be destroyed.

Termination

Either Client or Coach may terminate this Agreement at any time with one week written notice. Client agrees to compensate Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship.

Limited Liability

Except as expressly provided in this Agreement, Coach makes no guarantees, representations or warranties of any kind or nature, express or implied, with respect to coaching services negotiated, agreed upon, and rendered. In no event shall Coach be liable to Client for any indirect, consequential, or special damages. Notwithstanding any damages that Client may incur, Coach’s entire liability under this Agreement, and Client’s exclusive remedy, shall be limited to the amount actually paid by Client to Coach under this Agreement for all coaching services rendered through, and including the termination date.

Entire Agreement

This document reflects the entire agreement between Coach and Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered, or supplemented, except in writing, signe by both Coach and Client.

Dispute Resolution

If a dispute arises out of this Agreement that cannot be resolved by mutual consent, Client and Coach agree to attempt to mediate in good faith for up to 30 days after notice is given. If the dispute is not resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.

Severability

If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.

Waiver

The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver of limitation of that party’s right to subsequently enforce and compel strict compliance with every provision of this Agreement.

Applicable Law

This Agreement shall be governed and construed in accordance with the laws of the State of California without giving effect to any conflicts of laws provisions.

Binding Effect

This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns.

BY PAYING FOR SERVICES, YOU ARE AGREEING TO THESE TERMS.