First Name
Last Name
What do you preferred to be called?
Preferred pronouns?
Phone Number
Email
Please describe briefly the area of your life you are seeking coaching around?
What do you currently do as part of your personal growth journey?
Are you ready to invest at least 60 minutes weekly in session and 30 minutes weekly outside session to your personal development and inner transformation? If so, please describe a plan to set time aside in your schedule. It does not have to be a perfect plan, but there is power in making small commitments to ourselves.
Occasionally Brian may suggest written exercises to do between sessions. Are you open to completing some written self-reflection exercises as part of your journey? You do not need to share the content with Brian, the experience of the writing is where the healing transpires. Please briefly describe any fears or resistance that comes up around this.
How can I best serve you on our call?
Do you have any specific questions at this time?
Is there anything else you would like me to know?
Client and Coach acknowledge and agree that coaching is
a partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client.
Coaching services are designed to facilitate the creation/development of personal, professional, or career goals and to develop and carry out a strategy/plan for achieving those goals.
Coaching includes no guarantees or warranties, expressed or implied, about any results to be achieved.
Coaching is not therapy, counseling or advice giving and is not a substitute for psychotherapy, psychoanalysis, mental health care, substance abuse treatment, legal, medical or other professional services.
Coaching does not prevent, cure, or treat any mental disorder or medical disease and it is the Client’s responsibility to seek such independent professional guidance as needed.
Responsibility:
Coach will maintain the ethics and standards of professional behavior established by the International Coach Federation (ICF). The ICF Code of Ethics is available here: https://coachfederation.org/code-of-ethics
Client is responsible for personal, physical, mental, and emotional well-being and is solely responsible for decisions, choices, actions, and results.
Client agrees to inform Coach of past or current mental health or substance abuse conditions, including concurrent treatment with other professionals.
Coach is not and will not be liable or responsible for any actions or inaction, or for any direct or indirect result of any coaching services provided.
Confidentiality and exceptions to confidentiality:
Coach will keep all information and records confidential, to the extent defined by the laws of the state/country in which Coach and Client reside.
Coach will not disclose any information pertaining to the Client without the Client’s written consent.
Coach will notify appropriate mental health professionals and/or authorities if Client represents a danger to self or others.
Coach may be a mandated reporter of child and/or elder abuse.
Coach may share topics with other coaching professionals for training, supervision, and mentoring for professional development purposes without divulging any identifying Client information.
Coach and Client acknowledge that communications via text and email are not encrypted nor secure, and therefore may not be confidential.
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