Professional Coaching Agreement Treatment Contract
Welcome! This document contains important information about my professional services and business policies. It is rather long because it covers a wide range of possible situations, many of which may not apply to you. Still, it provides a framework for understanding the services you are considering. Please read it carefully and note any questions you might have. We can discuss them at our next meeting. If you decide you would like to use my services and sign this document, it will represent an agreement between us.
I. RIGHTS Confidentiality
All information shared in session is confidential except in circumstances governed by the laws including the mandatory
reporting of alleged harm to self or others, and in case of child, handicapped person, or elder abuse. The following are legal exceptions to your legal right to confidentiality. I will inform you of any time when I think I will have to put one of these into effect.
- If I have good reason to believe that a client will harm another person, I must attempt to inform the intended victim; I must also contact the police and ask them to protect the intended
- If I have good reason to believe that a client is abusing or neglecting a child or vulnerable adult, or if I have good reason to believe that a child in treatment has been abused, I must contact Child and/or Adult Protective Services within 48 hours.
- If I believe you are in imminent danger of harming yourself, I may legally break confidentiality and call the police. I will explore all other options with you before I take this
- I may have to release your records when ordered to do so by court I will discuss this with you beforehand.
Contacting Me
I am available via email (mmarino1955@comcast.net) and respond within 24 hours. If it will be difficult to reach you, please inform me of some times when you will be available. I will return the phone call as soon as possible. If you have an emergency; dial 211 for crisis intervention. If the emergency is life-threatening, dial 911 or go directly to the nearest emergency room.
Risk and Benefits
You have the right to know the potential risks and benefits of the treatment you are receiving. Treatment has both benefits and risks. It requires an investment of your time and energy in order to make the process of treatment the most successful. We will begin with a discussion or your needs and concerns and what it is you would like to accomplish by coming for treatment. Next, we will discuss a treatment plan in accordance with your goals and aims. Frequently, individuals go through periods in treatment which result in emotional discomfort, changes in their relationships, or temporary worsening of their symptoms. This should subside as the work progresses. Remember, you always retain the right to request changes in treatment or refuse/decline treatment at any time. You have the right to ask me questions about
anything that happens in treatment.
Right to a Referral
If I am not able to help you with my services, you have the right to a referral to another treatment provider who may be better able to meet your needs.
II. RESPONSIBILITIES
Professional Fees
The client or their guardian is considered responsible for the payment of professional fees. You will be expected to pay in advance for blocks of 3 sessions at $75 per session, a total of $225.00. Payment schedules for other professional services will be agreed to when they are requested. Payment must be received prior to sessions beginning. Payments may be made via PayPal at www.fromdarknesstodaylightgriefsupport.com/book-a-session/
Cancellation Policy
Once an appointment is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation. If you are late, we will still end on time and not run over into the next person’s session. If you miss a session without canceling, or cancel with less than twenty-four hours notice, you must pay for that session by the time of our next meeting unless we both agree that you were unable to attend due to circumstances beyond your control. In circumstances of unusual financial hardship, I may be willing to negotiate a payment installment plan.
You can cancel at any time. However, I do request that you try and provide at least a two-week notice prior to the cancellation of the coaching relationship. During the final two weeks, the coach will guide the relationship to a point of closure that will serve me most effectively as I move forward.
Due to Social Distancing, we are currently holding sessions via phone, messenger, or Zoom App.