1. As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during my coaching sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time.

2. I understand that coaching is a professional-client relationship I have with my coach that is designed to facilitate the creation/development of goals and then to develop and carry out a strategy/plan for achieving those goals.

3. I acknowledge that deciding how to incorporate coaching into any areas discussed, and implement my choices is exclusively my responsibility.

4. I understand that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association. I understand that coaching is not a substitute for licensed mental health care of any kind. I will not use it in place of any form of diagnosis, treatment or therapy. If I am currently receiving professional mental health care, I will consult with my caregiver to ensure working with a coach is in my best interest at this time.

5. I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law. I understand that if I reveal information that involves physically hurting myself or others, the coach must report such information and/or refer to mental health professionals accordingly.

6. I understand that coaching is not to be used as a substitute for professional advice by legal, medical, financial, business or other qualified professionals. I will seek independent professional guidance for legal, medical, financial, business or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my sole responsibility.

7. I understand that professional coaching is not considered medical consultation or treatment, and health insurance does not apply.

Client Signature: __________________

Date: _____________