Informed Consent Form
  • Informed Consent Form

    Relationality & Coaching Aliance
    Informed Consent Form
  • Please select the service(s) you are consenting to.
  • Is a Parent/Guardian filling out this form?
  • Client's Birth Date
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Soulciety61 | Relationality Coaching & Support Services


    Soulciety61 is a relational wellness organization offering coaching, facilitated support experiences, educational programming, and relational development services designed to support emotional, relational, psychosocial, and spiritual well-being.

    Our signature framework, Relationality Alignment, is a coaching and relational wellness approach that helps individuals, couples, and groups explore patterns, perspectives, relational dynamics, emotional awareness, and personal growth in ways that support healthier connection with self, others, and life.

    Soulciety61 services are designed to foster insight, reflection, emotional awareness, relational development, and practical movement toward greater alignment and well-being. Because each individual’s experiences, needs, and goals are unique, our approach is collaborative and tailored rather than one-size-fits-all.

    LeAnzar Stockley holds graduate-level education in Human Services Counseling and professional training in coaching, relational wellness, behavioral/mental health support, and grief recovery facilitation. While Soulciety61 services may feel supportive, reflective, or therapeutic in nature, they are not psychotherapy, psychiatric care, medical treatment, or licensed clinical mental health services.

    Soulciety61 coaching and support services are intended for personal growth, relational development, emotional support, and wellness-oriented guidance. These services are not designed to diagnose, treat, or cure mental health disorders or medical conditions.

    Clients are encouraged to seek licensed medical, psychiatric, or mental health care when clinical treatment or crisis-level support is needed.

    Soulciety61 highly values the coaching and relational alliance between practitioner and client and seeks to provide a respectful, collaborative environment that supports meaningful growth, insight, and responsible self-stewardship.

  • Client Rights and Service Terms

    Clients have the right to:

    1. Be treated with dignity, respect, and professionalism.
    2. Ask questions about services, approaches, expectations, or the coaching/support process at any time.
    3. Participate voluntarily and decline any exercise, reflection, or coaching approach that does not feel appropriate.
    4. Discontinue services at any time, subject to applicable scheduling, cancellation, or payment policies.
    5. Expect that personal information shared in sessions will be treated with confidentiality within the limits described below.

    Soulciety61 reserves the right to discontinue or decline services when it is determined that services are not an appropriate fit, when boundaries or agreements are repeatedly violated, or when the nature of the client's needs exceeds the scope of services offered.

  • Confidentiality


    Soulciety61 respects client confidentiality and handles personal information with care and discretion.

    Confidentiality may be limited where disclosure is required or permitted by law, including but not limited to:

    • Suspected child, elder, or dependent abuse
    • Credible threats of serious harm to self or others
    • Legal requirements such as subpoenas or court orders
    • Situations where written client authorization permits information sharing

    If services involve group participation, clients agree to respect the privacy and confidentiality of fellow participants and not disclose personal identifying information or stories shared within the group outside that setting.

    Brief session notes or administrative records may be maintained for service continuity, documentation, or business purposes.

  • Communication and Crisis Support


    Soulciety61 coaching and support services are not crisis response services.

    If a client is experiencing a mental health emergency, medical emergency, or immediate safety concern, they should contact 911, emergency services, or an appropriate crisis resource immediately.

    Communication between sessions via email, text, or messaging is intended for scheduling, logistics, or limited service-related communication unless otherwise agreed.

  • Payments and Scheduling

    Current service fees are available at leanzarstockley.com or communicated at the time of service enrollment.

    Unless otherwise agreed in writing, payment is due prior to scheduled services.

    Fees paid for completed services are non-refundable unless otherwise explicitly stated.

    Cancellations or rescheduling requests should be made at least 24 hours in advance. Missed appointments or late cancellations may be subject to the full session fee unless otherwise approved.

    Group memberships, subscriptions, or program-based services are billed according to the specific terms communicated for those offerings and are not prorated based on attendance unless explicitly stated.

  • Acknowledgement and Consent

    By signing below, I acknowledge that:

    • I have read and understand this informed consent agreement.
    • I understand that Soulciety61 services are coaching, support, and wellness-oriented services, not psychotherapy, medical treatment, or licensed clinical mental health care.

    • I understand that participation in services is voluntary.

    • I understand the confidentiality terms and their limitations.

    • I understand the payment, cancellation, and scheduling policies.

    • I accept responsibility for my participation, decisions, and personal well-being while engaging in services.

    • I understand that emergency or crisis support is not provided through Soulciety61 coaching services.

    • I agree to the Support Group Guidelines and Agreement if participating in group services.

    By signing below, I consent to participate in Soulciety61 services under these terms.

  • Date Signed
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