INDIVIDUAL COACHING SERVICE AGREEMENT - Tiffany Roe, LLC
1.0 Introduction: We feel it is important that as a client(s) you are fully informed about the coaching services you will be receiving and your expectations as we work together. Your signature(s) below indicates that you have received, read and understand this Agreement, made and entered into as of the effective date below( the “Effective Date”) between Tiffany Roe, LLC , (the “COACH”), a limited liability company located in Utah and the undersigned Client (the “Client” “You”) (collectively, the “Parties”). This Agreement takes effect immediately as of the Effective Date, and it remains in full force and effect until the Parties agree to complete the services.
2.0 Coaching Definition: The International Coach Federation states coaching is, “Partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”
3.0 Services: During the Term, the Coach will provide coaching services, (the "Services") via email, virtual sessions, and phone as jointly scheduled between the Parties. The coaching will address mental wellness coaching and also life coaching that supports client goals and will include directed questions from Coach and honest responses and participation from Client.
Packages:
- One (1) 1:1 50 minute Individual Coaching Session - $300 (can rebook unlimited amount of time)
SCOPE OF SERVICES
4.0. Scope of Services: Coaching services are a proactive approach to getting some guidance and support for daily living, achieving goals, or supporting during a life transition. You determine the nature and amount of change you wish to make. We use a goal-oriented approach and expect to work with you as a team in deciding the goals we will be working on. You have the right to ask questions about the coaching process at any time. There can be risks and benefits associated with coaching services. Most people experience improvement or resolution to the concerns they bring to sessions. However, there are no guarantees and sessions can open up new levels of awareness, which may cause pain or unease. Change is a difficult process and requires firm effort from all parties involved. Seeking to resolve issues between family members, marital partners and other persons can similarly lead to discomfort, as well as relationship changes that may not have been originally intended.
4.1. Limited Scope. Coaching does not equal therapy. Coach Tiffany Roe is not offering the services described here as a licensed therapist or mental health provider. Coaching does not follow a medical model. No mental health evaluation or diagnosis will be given. Clinical & therapeutic services will not be offered.
- 2. No dual relationships. To avoid dual relationships, a previous therapy client cannot transfer to coaching services.
4.3. Not for high-risk. High risk needs and related concerns are not appropriate for coaching level of services (suicidal ideation, self-harm ideation or behaviors, psychosis, substance abuse, active eating disorder behaviors).
4.4. Referrals. If a diagnosis or higher level of care is required, recommendations will be made to have this assessed and treated at a local level of care by a licensed professional.
4.5. No insurance. No insurance or third-party providers will be billed for coaching services.
4.6. No medical records. No official medical record will be kept (i.e. treatment plan, treatment notes, etc.). A basic file will be kept including general client information, general notes and goals currently being addressed.
CLIENT OBLIGATIONS
5.0. Client Obligations: You agree you are seeking and participating in this process on your own volition and are not being forced or coerced by anyone. You are willing to invest time and energy into this coaching relationship and understand that personal results will be based on your own individual effort and situation and that ultimately, you are responsible for enacting change in your own life. We promise not to be multitasking during sessions and ask for the same consideration from you (i.e. checking or replying to emails, texts, etc.).
CONFIDENTIALITY
6.0. Confidentiality: You have the right to confidentiality within certain limits, as the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and not privileged. Information revealed by you during coaching sessions will be kept confidential and will not be revealed to any other person or agency with the following exceptions:
You sign a written release of information indicating your consent to such a release, including your permission to be listed as a coaching client.
You express serious intent to harm yourself or someone else.
There is reason to believe that a child (17 or younger) or elderly person (65 or older) is being, has been or is in danger of being abused or neglected sexually, physically or emotionally (this includes any involvement with child pornography).
A subpoena or other court order is received directing the disclosure of information (it is our policy to assert privileged communication in such a situation, yet privilege may be overturned by a judge).
General topics, issues or themes discussed in coaching sessions may be anonymously and hypothetically shared with others only in a way that does not identify Client
PAYMENT/CANCELLATION
7.0. Payment: Payment shall be due before the start of the services via invoice. Any sessions scheduled will be considered used if cancellation is less than 24 hours before the appointment.
Automatic Credit card & Debit card Credit Card/ACH Authorization: Client’s card information is required to be in our automatic billing system and will be automatically charged at midnight following the appointment. Client is required to pay before the session if the card on file is not the preferred payment for current session. You, the undersigned, hereby authorize the Company to charge your credit card or debit card automatically according to the terms set forth in the Payment section above. In the case of an ACH transaction being rejected for Non Sufficient Funds (NSF), submission error, or other bank related return reasons, you understand and agree that we may resubmit the ACH debit transaction within thirty (30) days. You understand and agree that a 10% late charge will be assessed if the amount due is not received in good and collected funds by the end of the grace period. You also understand and agree that an additional charge may be assessed for each returned ACH debit. You also acknowledge that the origination of ACH transactions to Company account must comply with provisions of U.S. law and agree not to dispute this billing with your bank so long as the transactions correspond to the services detailed in this authorization form.
LIABILITY
8.0 Liability: EXCEPT AS EXPRESSLY PROVIDED IN THIS AGREEMENT, THE COACH MAKES NO GUARANTEES, REPRESENTATIONS OR WARRANTIES OF ANY KIND OR NATURE, EXPRESS OR IMPLIED WITH RESPECT TO THE COACHING SERVICES NEGOTIATED, AGREED UPON AND RENDERED. IN NO EVENT SHALL THE COACH BE LIABLE TO THE CLIENT FOR ANY INDIRECT, CONSEQUENTIAL OR SPECIAL DAMAGES. NOTWITHSTANDING ANY DAMAGES THAT THE CLIENT MAY INCUR, THE COACH’S ENTIRE LIABILITY UNDER THIS AGREEMENT, AND THE CLIENT’S EXCLUSIVE REMEDY, SHALL BE LIMITED TO THE AMOUNT ACTUALLY PAID BY THE CLIENT TO THE COACH UNDER THIS AGREEMENT FOR ALL COACHING SERVICES RENDERED THROUGH AND INCLUDING THE TERMINATION DATE. WHILE WE ARE DEEPLY COMMITTED TO PROVIDING CLIENT WITH ADVICE THAT WILL HELP CLIENT ACHIEVE THEIR GOALS, THE FINAL DECISION ABOUT ACTING ON ANY COUNSEL, AND THE RESULTS ACHIEVED, ARE CLIENT’S DECISION. COACH WILL BE INDEMNIFIED AND HELD HARMLESS FROM ANY CLAIMS, DEMANDS, CAUSES OF ACTION OR LITIGATION INCLUDING, BUT NOT LIMITED TO, ALL COSTS AND REASONABLE ATTORNEYS’ FEE, WHICH MAY ARISE OR BE INCURRED BY REASON OF THE SERVICES PERFORMED BY COACH.
DISCLAIMER
9.0. DISCLAIMER: Coach is not offering services as a lawyer, doctor, manager, therapist, financial analyst, accountant or other licensed professional . Client understands that Coach has not promised, shall not be obligated to and will not; (1) procure or attempt to procure employment or business or sales for Client; (2) perform any business management functions including but not limited to, accounting, tax or investment consulting, or advice with regard thereto; (3) act as a therapist providing psychoanalysis, psychological counseling or behavioral therapy; (4) act as a public relations manager (5) act as a publicist to procure any publicity, interviews, write-ups, features, television, print or digital media exposure for Client; (6) introduce Client to Consultant’s full network of contacts, media partners or business partners. Client understands that a business relationship does not exist between the parties after the conclusion of these services. If the Parties continue their relationship, a separate agreement will be entered into.
TERMINATION
10.0 Termination: Coach may terminate this Agreement at any time and refund a pro-rata balance of the remaining sessions, if applicable. Client can terminate only for cause and shall give Coach written notice detailing the nature of Consultant’s fault and possible remedies, whereupon Consultant shall have a reasonable period of time (but in no event less than 14 days) to cure such fault. Termination by Client without providing the foregoing notice and cure period shall be considered “termination without Consultant’s fault,” and Client will be responsible for the remaining balance of any service package, due within 15 days of an invoice. Client agrees to compensate the Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship, including any legal or collection fees for any outstanding balances, if needed.
11.0. No Transfer of Intellectual Property:
Any content or materials provided by Coach are copyrighted and are for Client’s individual use only as a single-user licensee. Client is not authorized to use any of Coach’s intellectual property for anything other than Client’s individual use. All intellectual property, including Coach’s program and/or course materials, shall remain the sole property of the Coach. No license to sell or distribute Coach’s materials is granted or implied. Client agrees that if Client violates, or displays any likelihood of violating, any of Client’s agreements contained in this paragraph, the Coach will be entitled to injunctive relief to prohibit any such violations and to protect against the harm of such violations. The Parties agree that any work product that arises from their sessions shall be assigned and transferred from Coach to Client without any further compensation and shall be considered a work for hire.
10.0. Emergency Services
10.0. Emergency Services: Coach does not provide any emergency services. If you are experiencing a mental health emergency, you need to call your primary care provider or dial 911. If for some reason, there is an emergency during one of our sessions (i.e. client becomes unconscious, etc.), you give me permission to contact your emergency contact (REQUIRED)
SAFE ENVIRONMENT
11.0 Safe Environment: You have a right to be treated with respect and dignity in a safe environment. Please feel free to approach us with any concerns about the services you are receiving.
FINE PRINT
13.0 Fine Print: This document reflects the entire agreement between the Coach and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented except in writing signed by both the Coach and the Client. If a dispute arises out of this Agreement that cannot be resolved by mutual consent, the Client and Coach agree to attempt to mediate in good faith for up to (certain amount of time such as 30 days) after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party. If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited. The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement. This Agreement shall be governed and construed in accordance with the laws of the State of Utah, without giving effect to any conflicts of laws provisions. Headings in this Agreement are for convenience only and do not confer rights or obligations, nor alter any terms of this Agreement.
By signing below you confirm that you have read the above information and agree to the terms of this Agreement. You understand that you are encouraged to ask questions and give input regarding entering into a coaching relationship at any time.