Welcome! We look forward to working with you. We know that starting the coaching relationship is a major personal step. And you may have many questions. The purpose of this document is to review what you can expect from coaching and to give you the opportunity to give consent to proceed with the coaching process. We will discuss this during our first session.

Professional Life and Relationship Coaching is a partnership between the Client and the Coach. It is a relationship that is characterized by the development and growth of the partnership toward the desired objectives. Together the Client and the Coach choose the focus and desired outcomes of the work they do together. The Client does not relinquish responsibility for creating and maintaining the desired outcomes and the Coach does not take full responsibly for them.

Coaching is for the person who want to move forward toward higher functioning. The goal is for the Client to improve learning, foster independence, and confidence. Coaching is designed to provide the Client with a greater capacity to produce results and be confident in this ability.

During the coaching process, the Client will work. The work is directed and guided by the Coach to support the Client and produce maximum results and success. The goal of that work is specifically what the Client has determined he/she want created in her/his life.

Coaching takes work and effort. It is work on the part of the Client and the Coach, as they work in partnership to design the objectives and implement the quality of life desired. This is not always a smooth path, and as things change and evolve, situation(s) may appear to be getting worse. Should this happen, dealing with it in honest and productive ways is to be understood and agreed upon as a focal point of coaching.

Professional Life and Relationship Coaching does not focus on regression to release past blocks. It is a helping partnership, in which the Coach listens and guides; the Client uses the guidance to make changes for the better in his/her life.

Your Coach will support you in creating the goals desired. The coaching session time and length of sessions will be mutually agreed up between the Client and the Coach. The first session is a longer session to discuss goals and the desired outcomes. To be successful, the Client will need to actively participate both during the sessions and at home. Coaching does not guarantee the Client's success, however with the right objectives and work, there will be movement to achieve excellence.

I am completing this consent for coaching for myself and attending with second client (as applicable)

Each client is to complete "Informed Consent for Coaching."

I am completing this consent for coaching for a minor child
format: MM/DD/YYYY

Fees/Sessions/Scheduling/Phone Calls

Coaching fees are not covered by health insurance (nor reimbursable) Our fee for the initial 75 minute session is $285 - $350, depending on the type of coaching and the coach selected. Following the initial appointment, the session cost ranges from $185 -$840, based on the coach you are working with & length of session. The fee is based on a 45 minute 'coaching hour'. The coaching sessions can range from 45 minutes for individuals up to 180 minutes (3 hours) for relationship coaching.

Coaching sessions can be in person, via video session, or phone session, depending on the agreement between the client(s) and the coach. Please note, if you request additional support between coaching sessions (i.e. phone coaching session), they will be billed, based on the time spent, at a per minute rate. We do not schedule less than 45-minute coaching sessions as a standard for client(s).

If an appointment is missed or not cancelled on or before 2 (two) business days - (Monday thru Friday, normal business hours) of scheduled time, the full fee of the missed appointment will be charged to the credit card on file. By signing this consent form, you authorize Pathways Counseling Services PLLC to charge your credit card if one is on file. If no credit card is on file, you will be responsible to pay the full fee or balance upon request and before the continuation of counseling services may be resumed.

Overdue accounts may be submitted to a collection agency or small claims court, and the cost of this collection effort would be passed on to you. Such efforts typically require disclosure of some otherwise confidential information, but we will limit this to the minimum information necessary. If such legal action is necessary, its costs will be included in the claim. There is a $35 fee for any returned checks. Refunds will not be issued for any services performed, including, but not limited to coaching sessions, telephone calls, or report writing.

To schedule an appointment, please call during regular business hours 8:30 am to 5:30 pm Monday thru Friday. Due to our work schedule, we are often not immediately available by telephone but will make every effort to return your call within 24 hours, with the exception of weekends and holidays.

In the event of a psychological emergency, please call the Maricopa County Crisis line at 800-631-1314 /988 or (602) 222-9444. In the event of a medical emergency, call 911 or go to the closest emergency room.

Social Media/Emails/SMS

We use a number of electronic tools in our practice, including computers and the internet, email, fax machines, telephones, and a cell phone. We may use these tools to store or communicate information about you and your treatment. While reasonable backup, security, and other safeguards are in place, there is always some risk of inadvertent disclosure of information that comes with using these tools. By signing this informed consent, you agree to accept the risk of disclosure that comes with tools that we use in our practice.

We do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, Twitter, Instagram, etc.). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our coaching relationship.

Regarding emails, you may contact us via email regarding non-urgent scheduling changes only. Be aware that the confidentiality of any email communication cannot be guaranteed. Therefore, we will only respond to emails requesting scheduling changes or requests. Do not use email for emergency contact.

Please do not use messaging on Social Networking sites such as Twitter, Facebook, or LinkedIn to initiate contact with us. These sites are not secure and we may not read these messages in a timely fashion. We will be utilizing SMS (text) messaging with you for contact regarding appointments or to respond to your inquiries, as applicable. Please be aware this is not to be used for urgent requests to the coach or for ongoing coaching purposes. If you need to contact us between sessions, the best way to do so is by phone or voicemail message.

Minors and Parents

Clients under 18 years of age who are not emancipated and their parents/legal guardians, should be aware that the law may allow parents/legal guardians to examine their child's coaching records. Because privacy in coaching is often crucial to successful progress, particularly with teenagers, we typically request that parents respect their children's privacy. We typically provide parents/legal guardians with general information about the progress of the child's coaching and general issues being addressed.

Coach - Client(s) Relationship

C. Client(s) 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. It is the Client's 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 the Client promptly inform the mental health care provider of the nature and extent of the coaching relationship agreed upon by the Client and the Coach.

D. The Client(s) understand that to enhance the coaching relationship, the Client agrees to communicate honestly, be open to feedback and assistance and to create the time and energy to participate fully in the program.

Please mark the corresponding box for each paragraph you read and understand below:

I choose to participate in coaching sessions with Pathways Counseling Services, PLLC and/or
I/We give permission to Pathways Counseling Services PLLC to provide coaching services to my/our minor child or individual with a guardian.
I understand that participating in these services is voluntary and collaborative, and that I may end services for myself or my child at any time. I agree to verbally advise Pathways Counseling Services PLLC when I decide to terminate services. I understand that, unless otherwise contacted or part of my coaching plan, no contact for 90 days will result in file closure; my file may be reopened upon agreement by both parties.
I understand that Pathways Counseling Services PLLC has a two (2) business day (Monday thru Friday, normal business hours) cancellation policy. If an appointment is missed or not cancelled within two (2) business days (Monday thru Friday, normal business hours) of scheduled time, full fee of the missed appointment will be charged to the credit card on file. When applicable, if I/we have a credit/debit card on file, I/we authorize Stephanie Levitt, MA, LPC, NCC, or Pathways Counseling Services PLLC to charge my/our credit/debit card for any costs which I/we have incurred and owe according to the policies listed in this consent agreement. . In the event of shared payments for the coaching sessions, if one of the payment sources does not clear for payment, the other parent/guardian/agreed upon responsible party will be charged the full amount. It is the responsibility of the parents/guardian/partner/responsible parties involved to coordinate reimbursement of funds paid.
I understand that Pathways Counseling Services PLLC may, at times, send text messages to my smart phone relating to my appointments, billing and general communication. I understand this communication is not to be used for emergency contact with Pathways Counseling Services, PLLC administrative staff or coaches. Text responses will be sent within 8 business hours (one business day, Monday through Friday) of receipt by intended recipient or administrative staff.

Signature for Client

I have read and understand the above information and agree to provide informed consent for counseling services at Pathways Counseling Services
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Minor or Individual with a Guardian

I/we, the parent(s) or guardian(s) of the minor/person with guardian listed below have read and understand the above information and agree to the informed consent for Pathways Counseling Services PLLC.
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