Client Agreement Form
Client Agreement Form (Sample Only)
*This form will be customized and emailed to each client in a .pdf)
After our initial consultation, the following details will help summarize expectations prior to entering into a personal coaching relationship. If you have questions or need further clarification, please contact me at your earliest convenience.
Client Name:
Fee/Payments:
$ per session
$ for the total series or project
$ per month
Other Details:
Sponsoring entity and details (if applicable): _______________________________________________________________________________________________________________________________________
Per session payments are due the same day as the session.
Monthly payments are due on the 1st of each month.
Checks to be made out to: Dusty Johnson 827 Salmonberry St. Springfield, OR 97477.
Debit/credit card payments can be made by selecting the MAKE A PAYMENT button at bottom of the Client Portal page.
Session Summary:
Day:______________ Time: ____________________
Number per month: ________________________
Session Type: __ Phone __ Zoom __ Other
Session Duration (most often 60 mins.): _____
Basic Ground Rules:
Clients will need to initiate the call or meet at the scheduled time/place.
Together we will set the agenda for each session based on what you want to work toward. Clients are responsible to work on their action steps before the next session.
If the need arises to cancel/reschedule a session, please provide at least 24-hour notice, otherwise you will be changed for that session.
Coaching is a two-way relationship, and your feedback is always appreciated.
Client Agreements:
I understand that sessions will be facilitated by Dusty Johnson, and I will make every effort to be ready for the session on time.
As a client, I understand and agree that I am fully responsible for my physical, mental, and emotional well-being during sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time.
I understand that payment is due on the day of each session unless otherwise arranged.
I understand that “coaching” or “spiritual direction” is a Professional-Client relationship and is designed to facilitate the creation/development of my personal, professional, or spiritual goals and to develop and carry out a strategy or plan for achieving those goals.
I understand that coaching/spiritual direction is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, spirituality, education, and recreation. I acknowledge that deciding how to handle these issues, incorporate coaching into those areas, and implement my choices is exclusively my responsibility.
I understand that coaching/spiritual direction 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 counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment, and I will not use it in place of any form of diagnosis, treatment, or therapy.
I agree that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with my health care provider regarding the advisability of working with a coach/spiritual director, and that this person is aware of my decision to proceed as a client.
I understand that coaching conversations are confidential, and my coach will not share our discussion with others without my permission.
I understand that for coach credentialing purposes my name and contact information, but not the contents of my coaching, may be given to the International Coaching Federation and other qualified organizations.
I understand that coaching and/spiritual direction 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 as the need arises. 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.
I have read and understand the agreements outlined above. I will email or bring a signed copy of this Client Agreement prior to the first session.
Date:
Client Signature: