Life Coaching Client Intake Form & Terms

• Coach agrees to be fully present during coaching sessions and communicates from a place of non-judgment and acceptance. 
• Coach agrees to maintain the ethics and standards of behavior established by the National Board for Health and Wellness Coaching (NBHWC). Please see https://nbhwc.org/code-of-ethics/ for complete ethics and standards. 
• Coach will utilize heightened communication skills, meaningful questions, and deliberate listening skills to support the client as a thinking partner. 
• Coach is intuitive and will guide the coaching sessions as the needs are communicated from the Client. Communication from the Client may be written, verbal, or non-verbal. 
• Coach is not a therapist or counselor. Coaching is not a substitute for therapy if needed.
  

• Client provides the Session Agenda(s) and is fully present during coaching sessions.
• Client takes ownership of his/her/their physical, mental, and emotional well-being, decisions, choices, actions, and results.
• Client agrees to communicate with integrity, be open to honest encouragement and assistance, and create the time and energy to participate fully in the program.
• Client acknowledges that coaching is a comprehensive process that may involve different areas of his/her/their life, including health, work, finances, relationships, education, and recreation. The Client agrees that deciding how to handle these 

issues, incorporate coaching principles into those areas, and implementing choices is exclusively the Client’s responsibility.

• Client accepts that coaching is not to be used as a substitute for professional advice by legal, mental, medical, or other qualified professionals and will seek independent professional guidance for such matters.
• Client understands that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association.
• Client understands that coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment. If the Client is in therapy or under the care of a mental health professional, the Client will consult with their mental health care provider regarding the advisability of working with a coach.

PLEASE NOTE.  THE VALUES IN THE BLANKS ARE ENTERED INTO THE COACHING AGREEMENT AND PAYMENT TERMS SECTION IN THE FORM.

This coaching agreement is valid as of ____________.

The parties agree to engage in a ____ month Coaching Program through in-person, internet, or telephone meetings.

The fee is $_______ and is paid in advance of sessions and/or $_______ per month based upon the committed schedule. Payment is due the same day of each month.

Fees will be paid via _________ prior to initial coaching session. If Client elects to pay in FULL, Client may pay the entire invoice on the provided due date.

The sessions/calls will be _______ minutes through internet, or telephone meetings.  Coach may be available to the Client by e-mail in between scheduled meetings as defined by the Coach. Coach may also be available for additional time, per the agreement of Coach and Client for an additonal fee to be determined and agreed upon prior to session. If Client is experiencing a crisis or medical emergency, please call 911 or go to the nearest emergency room.

After the Coaching program has begun, any unused sessions from a package purchase will not be refunded but may be rescheduled for up to 12 months after the initial payment. Refunds requested in writing before starting the Coaching program will be given in full, less a $50 administrative fee.  All unused sessions expire ___ months after the initial payment. However, unused Coaching sessions may be transferable provided the new Client is ready and willing to participate in the Coaching program actively. 

All information the Client shares with the Coach in the context of this relationship is bound by confidentiality (as outlined in the NBHWC Code of Ethics). However, please be aware that the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions). Thus, communications are not subject to the protection of any legally recognized privilege. The Coach agrees not to disclose any information about the Client or use the Client’s name as a reference without the Client’s written consent.

Confidential Information does not include information that: (a) was in the Coach’s possession before being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Coach from a third party, without breach of any obligation to the Client; (d) is independently developed by the Coach without the use of or reference to the Client’s confidential information; or (e) the Coach is required by statute, lawfully issued subpoena, or by court order to disclose; (f) is disclosed to the Coach, and as a result of such disclosure the Coach reasonably believes there to be an imminent or likely risk of danger or harm to the Client or others; and (g) involves illegal activity. The Client also acknowledges his/her/their continuing obligation to promptly raise any confidentiality questions or concerns with the Coach.

Client agrees that it is their responsibility to notify the Coach 12 hours in advance of scheduled calls/meetings. Coach reserves the right to bill the Client for a missed session. Coach will attempt in good faith to reschedule the missed appointment.

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

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

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