Susanna Smith currently participating in the Health & Well-Being Coach Training (DHWCT) Program at Duke Health & Well-Being. I understand that this form containing my name and contact information will be given to DHWCT Program staff. I understand that all information on this form will be kept strictly confidential.
I give my permission to have sessions with my coach recorded for training purposes. I understand that my recorded sessions may be reviewed by staff at Duke Health & Well-Being for the purpose of assisting my coach in his/her training. I understand that my coaching session should not be limited in any way by the fact that it is being recorded. I also understand that what is recorded will be held in strict confidence.
By signing below, I agree to have the information on this form shared with DHWCT Program staff and I agree to have coaching sessions recorded for training purposes.