Coaching Client Agreement And Disclosure Statement 

Wellness and Health Coaching:

 

As a Wellness and Health Coach we support and guide you in reaching your goals and well life  vision. Our job is to explore the lifestyle changes you want, facilitate a process of change and help you develop the tools you need,  self-efficacy and internal motivation towards actualizing yours dreams. The coaching services are designed jointly with the client;  together we will engage in direct and personal conversations. The client can count on the coach to be honest and straightforward in  asking questions and making requests towards your goals. The coach relationship is professional and strictly confidential. Typical sessions are 30 or 60 minutes held remotely.   

 

My professional qualifications are as follows:  

ISSA Certified Personal Trainer, Crossfit Level 1 Trainer, Precision Nutrition Coach, Crossfit Gymnastics Certified, Crossfit Mobility Certified, Bachelor's of Science in Food and Nutrition from University of Alabama (in progress).

 

File Records: You will have access to a copy of this disclosure statement at all times. All documents containing PII will be kept in a password secured drive. 

 

Recommendations: As my client, you should discuss any recommendations I provide with your Primary Care Physician, Obstetrician,  Gynecologist, Oncologist, Cardiologist, Pediatrician, Pediatric Health Care Provider, or other Board-Certified Physician.  

Termination Rights: You have the right to terminate your care at any time. I have the right to terminate your care if I feel your  needs would be best met at another practice or referral to a medical professional is necessary. I have the right to terminate your  care immediately with any verbal or physical threat or abuse of any kind. 

Informed Consent: The term “informed consent” means that the potential risks, benefits and alternatives of our services have been  explained to you. By signing below you are voluntarily consenting to our services and acknowledging receipt of our disclosure  statement: 

∙ I understand the nature of the Complementary and Alternative Health Care services to be provided and had any questions answered to my satisfaction.. 

∙ I understand the risks, benefits and alternatives to the coaching services provided. I understand that I am not being given a guarantee or being promised a specific result or outcome. 

∙ I understand that Health and Wellness coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, educations and recreation. I acknowledge that deciding how to handle these issues and implement my choices is exclusively my responsibility. 

∙ I understand wellness and health coaching is a relationship I have with my coach that is designed to facilitate the development of personal, professional, and/or business goals and to develop and carry out a strategy/plan for achieving those goals. ∙ I understand that I am fully responsible for my well-being during my coaching session, including my choices and decisions. I understand that if I am uncomfortable at any time during a session, I will inform the provider immediately and my concerns and alternatives will be discussed with me. I am aware that I can choose to discontinue coaching at any time and that professional referrals will be given if necessary. 

∙ I understand it is my responsibility to maintain a relationship for myself and/or my child with a medical doctor. I understand these services are not intended to replace any medical services prescribed by my doctor 

∙ I understand that Health and Wellness coaching does not treat mental disorders as described by the American Psychiatric Association. I understand that coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment, and I will not use it in place of any form of therapy. I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with this person regarding the advisability of working with a Health and Wellness coach and that this person is aware my decision to proceed with the coaching services. 

∙ I understand that wellness coaching is not to be used in lieu of professional advice. I will seek professional guidance for legal, medical, financial, business, spiritual, or other matters. I understand that all decisions in these areas are exclusively mine, and I acknowledge that my decisions and actions are my responsibility. 

∙ I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law. I understand that certain topics may be anonymously shared with other wellness coaching professionals for training or consultation purposes.

I voluntarily consent to the Health and Wellness Coaching services that I have obtained through McKenzie Enterprise LLC for myself.