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Coaching Agreement
Informed Consent and Coaching Agreement It is agreed and understood that:
First Name
Last Name
Email
Phone
Birthday
Address
Emergency Contact Name:
Emergency Contact Phone #
Please tell 3 things in your life that give you the greatest joy?
Overtime, what 3 things have you found to be your greatest motivators?
What are you most passionate about:
Please Describe What Your Higher Power (G-d) is doing in your life?
Do you have any fears or insecurities with the coaching process? (If yes, describe)
What one thing, if it were different or better, would make the greatest difference in your life right now?
What days are good for you?
Sunday
Monday
Tuesday
Wednesday
Thursday
What times are good for you?
Mornings 7am-11:30am
Afternoons 12noon-1:00pm
Evenings (Only if you live in Israel) 5pm-8pm
Coaching is not therapy, counseling, mental health care, or treatment for substance abuse. The coach is not functioning as a licensed mental health professional, and coaching is not intended as a replacement for counseling, psychiatric interventions, treatment for mental illness, recovery from past abuse, professional medical advice, financial assistance, legal counsel or other professional servi
Yes, I agree
Coaching is for people who are basically well-adjusted, emotionally healthy, functioning effectively, and wanting to make changes in their lives.
Yes, I agree
Coaching is designed to address issues the person being coached would like to consider – in other words, coaching is client-driven and coach-supported. These could include, but are not limited to, career development, relationship enhancement, spiritual growth, lifestyle management, life balance, decision-making and achieving short-term or long-term goals.
Yes, I agree
Coaching is designed to address issues the person being coached would like to consider – in other words, coaching is client-driven and coach-supported. These could include, but are not limited to, career development, relationship enhancement, spiritual growth, lifestyle management, life balance, decision-making and achieving short-term or long-term goals.
Yes, I agree
Coaching will be an ongoing relationship that may take a number of months, although either party can terminate the relationship at any time. All or most of the coaching will be through a HIPAA compliant teletherapy platform online.
Yes, I agree
Coaching will be an ongoing relationship that may take a number of months, although either party can terminate the relationship at any time. All or most of the coaching will be through a HIPAA compliant teletherapy platform online.
Yes, I agree
Coaching that involves business matters may be tax deductible. Please seek the advice of your local tax professional or accountant.
Yes, I agree
Coaching is most effective when both parties are honest and straightforward in their communication.
Yes, I agree
CONFIDENTIALITY – It is understood that the coaching relationship is a confidential one. The coach will never reveal any information about the client unless either directed to do so by the client or as required by the State of Israel law.
Yes, I agree
FEES - Coaching fees are on a sliding scale from $50-$130. The client pays on time before the session begins unless prior arrangements have been made.
Yes, I agree
FEES - Client agrees to pay $______/per session
Yes, I agree
SCHEDULE - Coaching sessions will last 50-60 minutes on agreed day and time. Days or times may be changed upon the agreement of both client and coach.
Yes, I agree
Clients need to give 24 hours notice if a session/call has to be cancelled or rescheduled. Clients should log online on time so that the full length of the coaching session can be used to the client’s benefit. Clients who don’t adhere to this request will be charged for missed sessions.
Yes, I agree
PAYMENT – via Paypal athttp://paypal.me/estherabta before session begins of amount agreed upon above or Zelle.
Yes, I agree
Should the coaching relationship be discontinued and re-started, the applicable fees current at that time shall apply.
Yes, I agree
The client understands and agrees to hold Esther Abta, Emuna Builders, Strides To Solutions harmless for any action the client takes or does not take. The client recognizes that he or she is in full control of their own life and makes their decisions accordingly.
Yes, I agree
The coach’s role is simply one of support to assist the client in achieving the goals the client wishes to accomplish. All final decisions to act or not act are the sole responsibility of the client.
Yes, I agree
A MUST – It is necessary for the client to implement the mutually agreed upon actions to feel that coaching is a success. You have hired a coach to do things differently than before. If you choose not to follow through, the results of coaching may be affected and goals may remain unattained or delayed.
Yes, I agree
CAN-DO ATTITUDE – The client agrees to arrive for his or her sessions with a “can-do” attitude, acknowledging that no progress can be made unless the client is willing to move forward.
Yes, I agree
If any section or item in this agreement is found to be inconsistent with any governing laws, the law of Israel shall prevail and the remainder of this agreement shall remain in full force and effect.
Yes, I agree
We are not a crisis service. Please do not call us in the event of a crisis. The Emergency Department, Ambulance or Police are crisis services.
Yes, I agree
Your Signature
Clear
Submit
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