Step N2 Success Coaching Agreement & Intake Paperwork

Consent for Coaching:

I consent to participate in coaching with Step N2 Success with me.  I understand that coaching is a process by which I am working on enhancing my current level of professional performance and/or personal life goals through the use of questionnaires and assessments, listening, asking questions, clarifying values, developing skills, overcoming obstacles, and working toward a high level of self-care.  A key part of my coaching will be to develop a coaching agenda that will outline appropriate action steps to move toward the achievement of my goals and aspirations.  I understand I need to actively participate in the process and be honest about my feelings and actions.  Although there are no guarantees to the outcomes of the coaching, most people do receive benefits from a coaching relationship.  I understand I may discuss the benefits, risks, alternatives, and nature of the coaching to be employed with my coach when requested.

Coaching is NOT Therapy:

I understand that coaching is NOT counseling or psychotherapy; therefore, if any issues arise that are better served in the therapeutic setting.  I understand my coach will provide me with referrals for psychotherapy.  I have the right to be treated with respect and dignity during coaching.  I will not be subjected to any verbal, physical or emotional abuse by anyone on staff.  I am aware I may terminate coaching at any time without consequence, but I will still be responsible for payment for the services I received.

Confidentiality:

I understand that all information discussed in the session confidential and that written permission is required for my coach to speak with anyone regarding our work together.  I understand that my coach does participate in professional consultation to assure I am receiving the best coaching possible.  I further understand that at times telephone conversations, e-mails or faxes may be utilized and that the confidentiality of information transmitted through these venues cannot be guaranteed.  Coaching is not a medial treatment and is not covered by HIPAA.


Because my coach is also a licensed mental health professional, I understand that he or she is legally and ethically to protect either myself or others from harm, and that my confidentiality may be limited in this instances.  This would include any information I might disclose that indicates that a child or elderly or, disabled person is being abused.  I further understand that if I am at imminent risk of hurting another, or myself, the coach is required to take protective action.  I understand that these instances are quite rate in coaching practices and that my coach will make every effort to discuss these matters with me prior to taking any action.

Grievances:

If I have complaint about my service, I will discuss it with my coach.  If that does not resolve the problem, I understand I may terminate coaching, but I will still be responsible for payment for the services I received.

Fees for Service:

My fee will be discussed and set with my coach during the first session.

Cancellation Policy:

I am aware that I must cancel appointments 24 hours in advance or I will be charged for the full session fee.  

Intake Forms- Session One

Please complete all three sessions and click submit once you complete each session.

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Intake Forms- Session Two

Please complete all the information and click submit to send the forms.

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Intake Forms- Session Three

Please complete all the information and click submit to send the forms.

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Thank you for submitting all the sessions and signing your forms!!  See you soon!

Step N2 Success