The Healing Self Program Application

The Healing Self Program Application

Application, Payment Plan and Terms and Conditions
Name

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The Healing Self Program Principles
Integrity: I commit to acting with honesty, transparency, and integrity in all interactions with clients. I will uphold confidentiality and safeguard your privacy, creating a foundation of trust essential for this transformative work.

Client-Centered Support: Your well-being, aspirations, and growth are at the heart of our work together. I will honor your autonomy, respect your pace, and support your personal development in alignment with your unique goals.

Professionalism: I hold myself to a high standard of professionalism in every aspect of our work, ensuring that each session provides a safe, respectful, and supportive environment.

Continuous Growth and Competence: I am dedicated to ongoing professional growth through continued education, self-reflection, and skill enhancement. This commitment enables me to provide the most effective, informed, and compassionate support.

Boundaries and Respect: I will maintain clear, professional boundaries in our relationship, respecting your personal space while fostering a productive and empowering dynamic.

Cultural Sensitivity and Inclusivity: I embrace the diversity of each client, honoring and respecting your cultural, social, and individual perspectives. My practice integrates a culturally sensitive approach that recognizes the impact of social and cultural contexts on healing and growth and works in alignment with the principles of Te Tiriti.

Avoiding Conflicts of Interest: I will avoid situations that could compromise the integrity, objectivity, or focus of our work together, prioritizing your best interests in all decisions.

Confidentiality and Safe Space: I adhere strictly to confidentiality in alignment with the New Zealand Association of Counsellors Code of Ethics, ensuring that all discussions remain private. Exceptions are only made when legally required or if there is a risk of harm to you or others.

Scope of Practice and Professional Referrals: I am committed to staying within the scope of my training, expertise, and therapeutic boundaries. When necessary, I will refer clients to other professionals who can provide specialized support beyond my area of practice.

Our coaching relationship
To ensure a harmonious and effective coaching relationship, we mutually commit to the following principles throughout our interactions as client and coach:

We will treat all discussions, information, and materials shared during our coaching sessions as strictly confidential, unless disclosure is required by law or mutually agreed upon.We will treat each other with respect, dignity, and professionalism, creating a safe and non-judgmental space for open communication and growth.We will honor the commitments we make to each other, including attending scheduled sessions, completing assigned tasks, and actively participating in the coaching process.We will work together to establish a foundation of trust, with the coach maintaining trustworthiness through ethical conduct and the client openly expressing their thoughts, concerns, and feedback.We will engage in open and honest communication, expressing our thoughts, feelings, and perspectives with transparency, while also being receptive to feedback and guidanceWe acknowledge that both the client and coach have unique responsibilities in the coaching process. The client takes ownership of their goals, actions, and outcomes, while the coach provides guidance, support, and accountability.We will embrace a growth mindset, being open to new ideas, perspectives, and possibilities. The client will actively work towards personal growth and development, while the coach continues to expand their coaching skills and knowledge.We will actively seek clarity and ensure alignment between the client's goals, values, and actions. The coach will help the client clarify their objectives and align them with their core values and desired outcomes.

Payment plan options
Please note you must be 18 to sign up to a payment plan, if you are under 18 please have a caregiver sign up for you as this is a legally binding agreement.

If you are a caregiver filling out the form on behalf, please add your details for this part.

If you are paying in full or using Afterpay I do not require your ID.
Pay in full or Afterpay $999

12x weekly $83.25

24x weekly $41.62

3x monthly $333
How would you like to invest?
Name of person applying for payment plan

First NameLast Name
Date of birth of person applying
Please note if you are applying for a payment plan (not applicable if paying in full or using Afterpay) then you must upload your drivers licence or passport below to be eligible

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Terms and conditions
- All payment agreements must be completed and paid in full during the agreed period of time.
- It is your responsibility to keep up with payments. Your payment day is the same day you make first payment (e.g if you start on a Monday all payments will be on a Monday)
- Healing with Mel offers no refunds once this agreement is signed you are liable for all and any payments, I hold this space for you and only work with a set amount of coaching clients at any given time.
- All property within my online platforms is the property of Mel Jay LTD and theft of the content will result in legal action.
- If client is needing to extend payment plan due to hardship this may be negotiated at my discretion but must be communicated via email by the applicant/student to healingwithmelz@gmail.com
- If client falls behind by 4 weeks, $100 dishonour fee will be applied and future appointments cancelled access to any of the clients online course + program will be removed with the full remaining balance + dishonour fee will be forwarded on to an external debt collector agency where student will be responsible for all and any additional fees applied.
Confidentiality:
- Confidentiality Policy: The coach will maintain strict confidentiality regarding all personal information shared during the coaching sessions, except in cases where disclosure is required by law or where there is a risk of harm to yourself or others.
- At times coach may use challenges from coaching session in the form of marketing and/or content, coach agrees not to make you identifiable unless agreed otherwise and explicit consent is gained.
- Your participation in the coaching program will remain confidential and not shared online or to anyone else unless explicit consent is gained.
The Healing Self Program Conditions:

By committing to the healing self program you fully understand that the insights and perspective I bring are from my own life experience. Healing with Mel is not a registered counselling or therapy practice - the word Therapy is the practice we undertake during our coaching sessions at times.I have a Bachelor of Arts double Major in Psychology and Social Anthropology & a Postgraduate Diploma in Counselling and Guidance. I am currently training to become a registered therapist but am not currently a practicing one. (Aim to be registered mid 2025 pending graduation).

Healing with Mel agrees to maintain a high standard of practice that is ethical.The clients information and sessions will remain confidential unless Mel believes that the client is a life threat to her/himself or others.

Healing with Mel at times will use modalities and alternative therapies to help guide and coach the client to reach desired goals and results but ultimately the results and impact of this service is dependent on the client.The client understands his/her healing/coaching journey is one they are responsible for and that Mel makes no promises for results.

You get access to me by Telegram Mon - Fri here you can ask me questions and I will answer within 24 hours, as well as our 90 minute zoom calls (12 in total)
- You must provide a minimum of 24 hours notice to reschedule any coaching calls, cancellation within 12 hours will not be rescheduled and will be cancelled without resheduling.
- All calls are held via zoom, please be on time for our calls
- You understand that no results are guarenteed, your results come from the work you put in
- As the client, you are responsible for actively participating in the coaching process, being open and honest in your communication, and working towards your goals to maximize the benefits of the program.
By signing the client understands all the above and waives all liability to Mel Jay LTD T/A Healing with Mel for all and any sessions they have & any risks involved.

Voluntary Participation:

Consent: By signing this agreement, you confirm that you have read and understood the information provided. You voluntarily consent to participate in the healing self program and understand that you may withdraw your consent at any time.
Do you agree and understand these terms and conditions?

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Once this form has been submitted you will receive an email with a link to make your payment - once payment has been received. I will be in touch within 48 hours with your onboarding package (during admin hours Tues - Fri) and to arrange our coaching calls.
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Do you understand and agree to all the terms and conditions in this payment plan agreement? By signing you understand you are entering into a legally binding agreement with Mel Jay LTD

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The Healing Self Program Application

The Healing Self Program Principles

I wanna know all about you, your visions and your goals!

Our coaching relationship

Payment plan options