Disclosure


Louise Warren
Personal Coaching Services
204 Dilworth Rd. High Point, NC 27265
PERSONAL COACHING CLIENT SERVICES AGREEMENT
effective August 1,2014

This document constitutes a contract between us. Please review it carefully. If while reading it, you have any questions, or require clarification before signing, please contact me via telephone at 336-402-5086 or via e-mail www.loveunfailing101@gmail.com, so I may answer your questions.

The personal coaching services provided are offered in office, or via telephone. In our coaching sessions, we will agree together upon issues you wish to work, and goals you wish to set for yourself. While coaching generally offers clients many benefits, there are no guarantees in how you will experience it for yourself. It is important that you openly discuss any dissatisfaction or concerns so that we can make the necessary adjustments in meeting your goals.

The focus of personal coaching is creation and implementation of strategies to reach client-identified goals of improved performance and personal satisfaction. Personal coaching may address specific personal goals, life balance, pre-marital and marriage goals. It will also address a look at our inner self.

Coaching utilizes personal strategic planning, values of clarification, brainstorming, motivational coaching, and other coaching techniques. You are likely to be given “homework” assignments as part of our work together, and you will get out of our work as much as you are willing to put into it.

Personal coaching does not diagnose or treat mental health disorders. Coaching is not reimbursable through health insurance policies, as psychotherapy often is.

APPOINTMENTS, HOURS AND LOCATION

Individual sessions are approximately 50 minutes, and can be scheduled by contacting me at 336-402-5086, or via email at love-unfailing @gmail.com.  

CANCELLATION POLICY

In the event that you are unable to keep an appointment, you must notify me 24 hours in advance (unless there is a reasonable emergency). If I do not receive such notice, you will be responsible for paying the full fee that we have agreed upon for coaching sessions. Forgetting or missing an appointment or call is not an emergency. If you need to cancel or reschedule our appointment you can call me at 336-402-5086.  Also, please remember to leave your phone numbers with every message so that I can get back to you even if I am not in the office, as I may not have your contact numbers with me.

URGENT ACCESS and TELEPHONE CALLS

If there is an urgent need to be in touch with me between sessions, I can be reached by phone at 336-402-5086. If contact of more than 15 minutes is necessary, you will be charged at my usual hourly rate. In very rare circumstances, I will conduct a crisis coaching session by telephone. If you would like me to give an example of when this might be appropriate, please ask me.

If you are unable to reach me when you feel the need for some urgent help, or if you are having a life threatening emergency, please call 911, go to your local Emergency Room, or call the 24-hour Crisis Line---High Point, NC

Alcoholics Anonymous
336-885-8520
Alcohol Abuse 24 hour assistance/treatment
1-800-234-1253
AAC-Alcohol Awareness Council
 
1-888-968-7541 
Child Find
1-800-426-5678
Family Services
336-889-6161
Family Services Crisis Line
336-691-7277
High Point Jail Inmate Search 
336-641-7900 
Missing Children
1-800-843-5678
NC Wildlife 
1-800-662-7137 
NC State Hwy Patrol 
 1-800-445-8621
Poison Control
1-800-848-6946
Rape 24 hr Number
336-889-7273
Runaway Hotline
1-800-231-6949
Teen Crisis
336-889-6161



CONFIDENTIALITY

I keep confidential client records for all coaching clients. In specific situations, I am required to disclose information without your consent or authorization to authorities. This includes, but is not limited to situations in which a client appears to be at risk to himself or others, if child abuse or neglect is suspected, or if yourrecords are subpoenaed for a legal case. These situations are quite unusual in coaching situations, and if it does arise I will make every effort to discuss it with you prior to taking the protective action.

It is impossible to protect the confidentiality of information that is transmitted electronically. This is particularly true of e-mail and information stored on computers.

FINANCIAL TERMS

My full hourly fee for coaching services is $75.00/session

 Fees for coaching telephone/office are to be made through PayPal prior to each session. Face to face sessions may either be paid through PayPal in advance or in person (via cash, ) at the time of our session. A receipt for your records will be offered in either case.

 YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS AGREEMENT AND AGREE TO ITS TERMS. IT ALSO SERVES AS AN ACKNOWLEDGEMENT THAT YOU HAVE THE OPTION TO TERMINATE YOUR PERSONAL COACHING RELATIONSHIP WITH ME AT ANY TIME.

By signing below, I attest that I have read, understood, and agreed to these policies, and have been offered my own copy of this disclosure.

_____________________________ _______________________________

Client’s Signature ___________________________Date________________

 Signature__________________________________Date________________

 
 

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