• Appointment Intake and Consent Waiver

  • Life Coaching Services: Life coaching practices and services are varying according to specific problems of clients. Since this is not an accredited profession and there exists no governing body or regulations requiring an official certification.

     There are many techniques that are applied by life coaches to be helpful for clients. Holistic life coaching duration can be varied with respect to the client’s obstacles. In this case, the coach has expertise, knowledge or experience in a particular area and coaches their clients to find the answers at their own pace. The patient accepts that coaching practices may include mentoring and guiding clients through particular area in their life. 

    Risks: Sessions have both benefits and risks because the session mainly involves various parts of clients lives. Clients may experience some undesirable feelings before, during and after each session. On the other hand, the session will provide solutions to problems and uncomfortable situations. Hence, the client accepts that he/she can benefit from life coaching sessions; however, the result is not certain and cannot be guaranteed.

    Confidentiality: Personal information of clients will be kept private and that is an obligation by the governmental laws. The coach is not responsible for any pain or discomfort, during and after life coaching sessions.

    Responsibility: I understand and agree that I am fully responsible for my well-being during my coaching sessions, and subsequently, including my choices and decisions.

    I understand that all comments and ideas offered by my Coach are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to my coach to assist me in achieving such goals.

    I understand that the use of technology is not always secure and I accept the risks of confidentiality in the use of email, text, phone, and other technology.

    I hereby release, waive, acquit and forever discharge my Coach, any agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or by my Coach as a result of the advice given by my Coach or otherwise resulting from the coaching relationship contemplated by this agreement. I further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents.

  • The coach may withdraw you from this study at any time he/she feels it is in your best interest. The session will continue until the coach and/or you decide to stop. This may include discontinuation without your consent. The coach in charge of this protocol may remove you from the session without your consent based upon his/her medical judgment regarding your safety or due to your willful failure to follow through.

  • I * verify that all information is correct and current to the best of my knowledge. I understand that any information provided is for safety purposes and will be kept strictly confidential, unless I provide written consent. I hereby give my consent to receive sessions and I acknowledge and agree that I am doing so at my own risk. My health and safety with respect to such services are my sole responsibility. My decision to receive services is voluntary, and I know of, understand and assume any and all the risks associated therewith. In exchange for receiving services for myself and on behalf of my heirs, executors, administrators and personal representatives, hereby waive, release, discharge and hold harmless (Coach KJ) (life coach) from any and all liability for any and all injuries, including damages or claims relating to or resulting from my receipt of the services, now or in the future, foreseen or unforeseen.


  • By signing below, you acknowledge that you have read this Consent Form, you have been given the opportunity to ask questions and you understand what this coaching session involves. You freely consent to participate in coaching, and that you may leave the session at any time. You also acknowledge that you have received an appropriately executed copy of this informed consent.

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