YOUR COMMITMENT AND AGREEMENT
• I understand that I must be fully committed to making positive changes in myself to see beneficial results. To this end, I authorize this practice to engage me in spiritual counseling/coaching and I commit to following the mutually-agreed upon actions given me during my sessions, and to keep all scheduled appointments.
• I understand that staff members of this practice are not state licensed medical or mental healthcare professionals and do not prescribe drugs, diagnose medical/mental conditions, or provide therapeutic treatment or advice for such conditions. Nothing contained in any information provided by the staff or this practice, either verbally or in print, is intended to constitute or be construed as professional medical or psychotherapeutic advice for diagnosis or treatment. The methods used by this practice are transpersonal coaching, general personal growth and empowerment techniques, positive suggestion, guided imagery, visualization, and/or relaxation techniques.
• I understand that staff members of this practice are ethically and legally bound to protect the confidentiality of our communications. I understand that you will only release information about our work to others with my written permission or in response to a court order. I understand that there are some situations in which you are legally obligated to breach confidentiality in order to protect me or others from harm. I understand that if you receive information that indicates a child, elderly, or disabled person is being abused, you must report that to the appropriate state agency. I also understand that if I become an imminent risk to myself or make threats of imminent violence against another, you are required to take protective actions by filing a report with local law enforcement.
• I understand that the results of my sessions depend greatly upon my own serious participation and, therefore, this practice cannot offer any guarantee of the success of my sessions. I am aware, however, that this practice will do everything reasonably possible to ensure my success.
• I agree to pay for all services when rendered (unless prior arrangements have been agreed upon). I understand that, except for emergencies, 24 hours notice must be given when cancelling or rescheduling an appointment otherwise I agree to pay for the missed appointment.