INSITE Intake Form

Consulting/Coaching Intake Form

Ed Geraty LCSW-C, LICSW
Date of today*

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Name*

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Please let me know what goals you would like to address personally or professionally. Be specific.
Agreement

The fee for a 55 minute coaching session is 100$. Twenty-four hour notice via text to 410-804-1934 is required to avoid a no show /late cancelation fee of 75$. Your coaching fees can be paid prior to your appointment on my website payment page at www.INSITEintegrative.com . Signing this form indicates you agree to the above.
DISCLAIMER:

Coaching is not psyhotherapy: Coaches assist someone in creating a plan for achieving specific goals – for example, making a change in their career, diet or relationships. It can be effective in helping people manage chronic conditions, such as diabetes, between doctors’ visits and to follow their treatment plan. Coaching is a forward-focused approach that helps you set goals, develop strategies, and achieve more specific outcomes. Coaching is not a mental health service and therefore is not based on a mental health diagnosis and treatment. This service cannot be billed to your insurance company, but could be considered a tax deductible expense ( consult your tax person).

Psychotherapy, often focused on healing and addressing emotional and psychological issues, provides a safe space to explore your past, understand your present, and overcome challenges.  Therapists work with clients to uncover the root causes of their challenges, develop coping strategies, and facilitate a deeper understanding of the self. Psychotherapy does require a mental health diagnosis and can be billee to your insurance company
Reminder

A reminder to text me at 410-804-1934 and let me know you have submitted this Intake form. Ed Geraty LCSW-C By submitting this form you are indicating that you have read and agree to the above, understand the difference between coaching and psychotherapy services, and that you are requesting Coaching services.
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Consulting/Coaching Intake Form

Agreement

Reminder