Client Intake & Agreement – Untying the Knot HCDC, LLC
Please provide your information, review the service terms, and acknowledge your agreement to proceed with coaching services.
Basic Information
Full Name
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First Name
Last Name
Email
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example@example.com
Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
Briefly describe your current situation
Important Notice: This service is structured, boundary-based coaching designed for high-conflict situations. Clients seeking immediate, continuous, or crisis-level access may not be a good fit for this service.
Client Agreement & Acknowledgment
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I understand this service is coaching, not therapy, legal advice, or crisis intervention
I understand support is provided during business hours only and is response-based, not real-time
I understand this is not a 24/7 service or crisis hotline and does not provide continuous or immediate communication access
I understand scheduled sessions take priority over message responses
I agree to communicate in a respectful, regulated manner and follow all boundaries
I understand that verbal abuse, excessive messaging, or disregard for boundaries may result in immediate termination of services
I understand I am expected to actively engage in the coaching process and implement strategies provided
I understand services may be paused or terminated at any time if I do not adhere to expectations
I understand no refunds will be issued if services are terminated due to violation of these terms
I understand I am responsible for my own decisions and outcomes and results are not guaranteed
Payment & Cancellation Policy
All services must be paid in full prior to the start of services. Payment secures your spot and access to services during the agreed timeframe.
Sessions must be rescheduled with at least 24 hours’ notice. Missed or late-canceled sessions may be forfeited.
Due to the nature of coaching services, all payments are non-refundable. No refunds will be issued for unused time, missed sessions, early termination, or violation of agreement terms.
Services may be terminated at any time if client conduct violates expectations, boundaries are not respected, or engagement is insufficient. No refunds will be issued in such cases.
Date
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Month
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Day
Year
Date
Final Agreement
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I have read, understand, and agree to the terms above and wish to proceed
By clicking and submitting this form I agree
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