CONSENT TO COACHING SERVICES
I understand that Darlene Lancer is a Certified Life Coach who provides services, which are alternative and complementary to mental and behavioral health services licensed by my State. She is not a licensed professional counselor in my state. I am engaging her services in accordance with her education, training, and experience as an author and codependency recovery coach with a Masters in Psychology and Certificate of Life Coaching. Distinct from counseling, coaching is an interactive process that improves function and performance through learning, using a variety of styles, skills and techniques. I’m not seeking psychological or counseling services or any other healing art, and I’m aware that coaching is not covered by medical insurance.
FEES AND CONFIDENTIALITY POLICY
Fees are payable prior to appointment. They may be adjusted upon notice to client.
Payment is via Zelle or Paypal sent to [email protected]. If made via Paypal, I am responsible for Paypal’s transaction fees. I may send money to www.paypal.me/darlenelancer or on the website Contact page. Personal checks may be sent to Darlene Lancer, but appointments will not be scheduled until payment has cleared the bank.
I am responsible for payment for any missed appointment, unless it is rescheduled upon at least 48 hours prior notice, subject to coach’s availability. If the appointment is not rescheduled, or if I give less than 48 hours cancellation notice, I will be charged for the canceled session. Sessions purchased as part of a package must be weekly. No reimbursement or substitution will be made for any weekly appointment that is missed or skipped.
Interest of 1 1/2% per month accrues for balances 10 days past due. A $12 fee will be charged for any check returned for insufficient funds. I agree that I’m responsible for all costs, fees, and expenses for collection of past due balances, including legal fees.
I acknowledge that coaching is based on a working relationship with my coach and that communication with her is an important part of our work together. If I decide to suspend or discontinue treatment for any reason after the third session, I agree to schedule a final coaching session to talk about it and review and conclude our work together.
I UNDERSTAND THAT CONFIDENTIALITY MAY BE WAIVED IF MY COACH BECOMES AWARE OF CHILD ABUSE OR ELDER ABUSE, OR IF I PRESENT A DANGER TO MYSELF OR OTHERS.
I UNDERSTAND THAT EMAIL IS NOT CONFIDENTIAL. I AUTHORIZE THE USE OF ELECTRONIC COMMUNICATION AND UNDERSTAND THAT MY PRIVACY AND CONFIDENTIALITY CANNOT BE SECURED WHEN USING ELECTRONIC COMMUNICATIONS, SUCH AS THE TELEPHONE, SKYPE, EMAIL, AND OVER THE INTERNET. ALTHOUGH MY COACH WILL TAKE ALL REASONABLE STEPS TO ENSURE THAT OUR CONVERSATIONS ARE PRIVATE AND CONFIDENTIAL, COMMUNICATION BY TELEPHONE CANNOT BE GUARANTEED 100 PERCENT SECURE AND PRIVATE. I WAIVE MY PRIVACY AND CONFIDENTIALITY RIGHTS WITH RESPECT TO ALL ELECTRONIC COMMUNICATIONS AND TRANSMISSIONS.
I UNDERSTAND THAT A TELEPHONE SESSION LOSES CERTAIN BENEFITS OF FACE-TO-FACE INTERACTIONS. I WILL NOTIFY MY COACH OF THE ADDRESS OF MY REMOTE LOCATION IF I’M NOT AT MY HOME AT THE BEGINNING SUCH TELEPHONE SESSION.