Freedom Fighters Therapy LLC Life Coaching Intake Packet

Freedom Fighters Therapy LLC provides professional nationwide life coaching services through secure telehealth technology.

Life coaching is a non-clinical service and is available to clients throughout the United States. Life coaching is not psychotherapy, counseling, mental health treatment, or a substitute for professional medical or psychiatric care.

Submitting this intake does not guarantee a coaching appointment. Your completed intake paperwork and required $95 Life Coaching Session Fee will be reviewed by our office before your appointment is confirmed.

Emergency Notice

Freedom Fighters Therapy LLC is NOT an emergency service.

If you are experiencing a medical emergency, mental health crisis,
believe you may harm yourself or another person, or require immediate
assistance:

• Call 911
• Call or Text 988
• Go to the nearest Emergency Department

Please do not use this intake form, email, voicemail,
text message, or the client portal to request emergency assistance.

Please complete the following information exactly as it appears on your legal identification and insurance records (if applicable).

Please answer the following questions as completely and accurately as possible. These questions help your clinician prepare for your first appointment and develop the most appropriate treatment plan or coaching approach.

Please tell us your scheduling preferences. While we cannot guarantee specific appointment times or providers, we will make every effort to accommodate your preferences.

Thank you for choosing Freedom Fighters Therapy LLC for Nationwide Life Coaching services.

This agreement explains the nature of life coaching, fees, scheduling expectations, payment policies, confidentiality, communication, and client responsibilities.

Please read each section carefully before continuing.

Life coaching is a professional, goal-oriented service designed to help individuals improve personal growth, relationships, career development, leadership, resilience, motivation, and overall life satisfaction.

Life coaching is NOT psychotherapy, counseling, psychological treatment, psychiatric care, or medical treatment.

Life coaching does not diagnose, treat, or prevent mental illness and should not be considered a substitute for licensed mental health treatment.

If your coach believes your concerns would be better addressed through licensed mental health treatment, you may be encouraged to seek therapy or other appropriate healthcare services.

Freedom Fighters Therapy LLC reserves the right to discontinue coaching services and recommend clinical treatment when coaching is no longer the appropriate service.

Life coaching focuses on future goals, personal development, accountability, decision-making, stress management, relationships, confidence, career growth, and overall life improvement.

The coaching relationship is collaborative and is designed to help clients identify goals, develop action plans, and create meaningful change.

Current Nationwide Life Coaching Fees

• $95 per coaching session

Payment is required before each scheduled coaching session.

Appointments are scheduled after payment has been successfully processed.

Freedom Fighters Therapy LLC reserves the right to postpone or cancel appointments when payment has not been received.

Appointments canceled with less than twenty-four (24) hours notice or missed without notice may be charged the full $95 coaching session fee.

Repeated missed appointments may result in discontinuation of coaching services.

Information shared during life coaching sessions will be treated respectfully and confidentially.

However, life coaching is not protected by therapist-client privilege in the same manner as licensed psychotherapy.

Freedom Fighters Therapy LLC will comply with all applicable federal and state laws regarding privacy and required disclosures.

Routine communication may occur through secure text messaging, telephone, email, or other approved electronic communication methods for scheduling and administrative purposes.

Electronic communication should never be used for emergencies.

Life coaching is not an emergency or crisis service.

If you experience thoughts of harming yourself or another person, call 911, call or text 988, or go to the nearest emergency department immediately.

The following policies apply to all clients receiving Nationwide Life Coaching services through Freedom Fighters Therapy LLC.

These policies explain the coaching relationship, privacy practices, communication expectations, tele-coaching procedures, client responsibilities, and informed consent for coaching services.

Please read each section carefully before continuing.

I voluntarily consent to participate in life coaching services provided by Freedom Fighters Therapy LLC.

I understand that life coaching is designed to support personal growth, goal achievement, resilience, leadership, relationships, career development, and overall wellness.

I understand that no guarantees can be made regarding the achievement of personal goals or coaching outcomes.

Life coaching is a non-clinical professional service.

Life coaching is not psychotherapy, counseling, psychology, psychiatry, social work, substance abuse treatment, or medical care.

Life coaching does not diagnose, treat, or prevent mental illness.

If coaching is determined to be inappropriate for your needs, Freedom Fighters Therapy LLC may recommend licensed mental health treatment or other appropriate healthcare services.

Freedom Fighters Therapy LLC respects your privacy and treats coaching information confidentially.

Information will only be released with your written authorization or when required by law.

Although life coaching is not considered psychotherapy, Freedom Fighters Therapy LLC applies privacy practices designed to protect your personal information.

Most coaching sessions are conducted through secure virtual platforms.

You agree to participate from a private location whenever possible.

If you experience technical difficulties, every reasonable effort will be made to reconnect or reschedule your session.

Freedom Fighters Therapy LLC may communicate using secure telephone calls, text messaging, email, electronic forms, and approved client communication platforms for scheduling, reminders, billing, and administrative purposes.

Electronic communication should never be used during emergencies.

Text messages and email are intended for scheduling and administrative communication and should not be relied upon for urgent concerns.

Freedom Fighters Therapy LLC may use secure technology tools, including AI-assisted documentation support, to improve coaching documentation and administrative efficiency.

The coach remains responsible for reviewing, editing, and approving all documentation.

AI tools are never used to replace professional judgment.

Clients have the right to:

• Participate in coaching goal development

• Ask questions regarding coaching services

• Receive respectful, nondiscriminatory services

• Receive information regarding fees and scheduling

• File complaints without retaliation

Clients are expected to:

• Participate honestly

• Keep contact information current

• Attend scheduled appointments

• Treat staff respectfully

• Notify the practice of scheduling changes as soon as possible

If you have concerns regarding your coaching services, please discuss them with your coach or contact Freedom Fighters Therapy LLC administration.

Every concern will be reviewed fairly, respectfully, and without retaliation.

Freedom Fighters Therapy LLC's Nationwide Life Coaching program is not an emergency or crisis-response service.

If you experience thoughts of harming yourself or another person, call 911, call or text 988, or go immediately to the nearest emergency department.

If your needs become clinical in nature, your coach may recommend that you seek therapy or other appropriate healthcare services.

To simplify billing and help avoid interruptions in your care, Freedom Fighters Therapy LLC requires a valid credit or debit card to be securely stored on file for most non-VA services.

Your card information will be stored using encrypted, PCI-compliant payment processing and will not be retained by Freedom Fighters Therapy LLC in an unencrypted format.

By signing this authorization, you authorize Freedom Fighters Therapy LLC to securely maintain your payment method on file and to charge your card, when applicable, for:

• Deductibles
• Copayments
• Coinsurance
• Self-Pay therapy sessions
• Life Coaching sessions
• Outstanding balances
• No-show fees
• Late cancellation fees
• Returned payment fees
• Medical record fees (when applicable)
• Court-related fees (when applicable)

Charges will only be processed in accordance with your signed financial agreements and applicable practice policies.

Whenever reasonably possible, clients will receive an explanation of charges before payment is processed.

If a payment is declined, Freedom Fighters Therapy LLC may contact you to obtain updated payment information before scheduling future appointments.

Clients agree not to initiate chargebacks for services that have been provided in accordance with this agreement.

Questions regarding billing should first be directed to Freedom Fighters Therapy LLC so that concerns may be reviewed and resolved.

I authorize Freedom Fighters Therapy LLC to securely maintain my payment method on file and process charges as described in this agreement.

I understand that this authorization will remain in effect until I revoke it in writing or until services are terminated, subject to any outstanding financial obligations.

I authorize Freedom Fighters Therapy LLC to securely maintain my payment method on file and process charges as described in this agreement.

I understand that this authorization will remain in effect until I revoke it in writing or until services are terminated, subject to any outstanding financial obligations.

This authorization allows Freedom Fighters Therapy LLC to release and/or obtain information necessary to coordinate your care, verify insurance or VA benefits, communicate with healthcare providers, and process referrals when authorized by you or required by law.

You may revoke this authorization at any time in writing unless action has already been taken in reliance upon it.

I understand that I may revoke this authorization at any time by providing written notice to Freedom Fighters Therapy LLC.

Revocation will not affect actions already taken in reliance upon this authorization.

Please review the statements below carefully before signing.

By electronically signing this intake packet, you acknowledge that you have read, understood, and agreed to all applicable policies, consents, financial agreements, and disclosures presented within this Master Intake Packet.

Thank you for completing the Freedom Fighters Therapy LLC Master Intake Packet.

Your information will be reviewed by our administrative team. If additional information is needed, we will contact you.

If payment is required based on the services you selected, you will proceed to the secure payment page after clicking Continue.

Thank you for completing your Freedom Fighters Therapy LLC intake paperwork.

If payment is required for the service you selected, please complete the payment below.

Nationwide Life Coaching – $95.00

Please select the payment option above to complete your intake.

All payments are securely processed through Stripe. Freedom Fighters Therapy LLC does not store your complete credit or debit card information.