Informed Consent for Telecoaching & Telecounseling Services
All clients begin our services through our curricula, and coaching begins within the curricula in the reflection response sections. We ask you to read and sign the informed consent agreement to initiate your connection with our coaching team.
The following information is provided to clients who are seeking telecoaching services. This document covers your rights, risks and benefits associated with receiving services, our policies, and your authorization. Please read this document carefully and note any questions you would like to discuss.
You have the right to decide to end our coaching work at any time without prejudice. If you wish, we will provide you with the names of other qualified coaches.
You have the right to ask any questions about procedures used during coaching. If you wish, we will explain our usual method of coaching practices with you.
You have the right to refuse the use of any coaching technique. We will inform you if we intend to use any unusual procedures and explain any risks involved.
You have the right to learn about alternative methods and services. I will discuss these with you during our work together.
Telecoaching services are not appropriate for all clients. Generally, those who are experiencing suicidal ideation, altered mental status, or any significant mental health disorders, are not appropriate. Telecoaching is not a substitute for psychiatric or psychotherapy services. Should telecoaching services not be a good fit for you, I will assist you in finding alternative options.
Benefits and Risks
Telecoaching refers to coaching services that occur via phone, email, or synchronous video conferencing. All of our interactions will fall under this term. When using technology there is always the risk of security issues, as well as technical issues (phone not charged, computer or software not working, etc.) You will develop an individualized plan for how best to address technical issues that may arise and take steps to facilitate the security of interactions with your coach. In addition to the identified risks, there are several benefits that come from using technology. For instance, it allows opportunity for more flexibility in scheduling, and convenience in being able to connect from a space of your choosing. In order to protect your confidentiality and to facilitate the security of your information as much as possible, here is a list of recommendations:
Engage in sessions in a private location where you cannot be heard by others
Use a private phone
Do not record any sessions
Password protect any technology you will be interacting with your coach on
Always log out or hang up once sessions are complete
Freedom U protects the privacy and confidentiality of the communications with its clients. At no time will Freedom U voluntarily divulge the coaching relationship between themselves and their clients without written permission from the clients, unless required to do so by law.
Emergency Management Plan
Freedom U does not provide emergency services. In the event of an emergency, it is imperative you are aware of resources in your area. As a precaution, please identify two (2) nearby emergency hospitals below. In addition, you will need to provide information for an emergency contact person. These all must be filled out to participate in coaching services.
Contacting Your Coach & Counselor
Email is the main form of contact that will be used outside of the consultation and sessions. Please note that email is not completely secure, so communication should be limited to scheduling questions, providing resources, etc.
Coaching & Counseling Commitment
I will honor the time that we are together and hold your confidences.
I will not judge you and will respect your perceptions of the world.
It is not my job to change you. It is my privilege to bring into awareness, clarity of choices, and if your choose, action to your life.
This is my personal commitment to be impeccable with my word and keep my commitments to you.
I will present an open heart.
I will always hold you in positive focus. We will concentrate on what is working in your life and how to create more that will work for you.
I ask you give 24 hours notice if you need to cancel or change the time of appointment. I will make every effort as well, to reschedule sessions which are cancelled in a timely manner. Cancellation less than 24 hours before and/or no-show appointments are billed to the client for the full amount. If the client is more than 10 minutes late for a coaching session and has not notified the coach he will be late, the coach will assume the session is cancelled and the client will forfeit the session fee.
Limitation of Liability
IN NO EVENT SHALL FREEDOM U WELLNESS INSTITUTE BE LIABLE TO CLIENT FOR ANY SPECIAL, PUNITIVE, INCIDENTAL, INDIRECT, OR CONSEQUENTIAL DAMAGES OF ANY KIND IN CONNECTION WITH THIS AGREEMENT.
This contract constitutes the entire agreement between the client and the coach and the coach shall not be held responsible and shall remain blameless for any adverse or other consequences, including but not limited to financial, personal, employment or other losses, arising out of decisions or actions the client may make as a result of the services provided by the coach.