Executive Health and Wellness Coaching Agreement
Client Name: ___________________________________________________
This agreement, between Dr. Christina Villarreal and the above-named client will begin on (date)_________________ .
The fee for the initial consultation is $_________________ and the fee for the following coaching sessions is $________________. These fees will be paid in advance or at the time of the session.
If you need to cancel an appointment, please provide at least 24 hours notice or unfortunately, you will be responsible for the cost of the missed session. You may notify me of an upcoming cancellation during a coaching session, by email, voicemail, or text.
The coaching services provided by Dr. Christina Villarreal are conducted face-to-face or via phone/video chat, as agreed upon jointly with the client. The role of a coach is to be a collaborative thought partner with clients as they pursue specific professional or personal goals, projects, or phase of life transitions. Coaching services may include action plan development, execution support, leadership development, emotional intelligence skill building, decision-making, problem solving, and interpersonal communication practice for personal and professional relationships. Dr. Villarreal’s coaching style is positive, strength-based, and strategic, and uses cognitive neuroscience and behavioral design techniques to support client growth.
The client understands that successful coaching requires a co-active, collaborative approach between client and coach. The coach aims to facilitate purposeful change, but it is the client’s responsibility to enact or bring about the change. Clients are encouraged to routinely provide feedback to their coach to assist with progress development.
The client agrees to disclose relevant details of past or present psychological or psychiatric treatment in order to determine if engaging in executive health and wellness coaching is appropriate at this time. Coaching is not to be considered a replacement or form of psychotherapy and/or psychological services for the treatment of mental health disorders. Please be informed about the difference between professional coaching and psychological treatment on the website http://www.drchristinavillarreal.com under “Dr. Villarreal’s Coaching Practice” in order to distinguish specifically when engaging in professional coaching is appropriate.
Although I have formerly practiced as a clinical psychologist, I do not engage in psychotherapy services with my coaching clients. In entering into the coaching relationship, and signing this agreement you are agreeing to notify me immediately should you begin to experience notable mental health impairment during the course of our work together. I can discuss with you a referral so that you may receive the appropriate form of professional care.
The client can, at any point in the coaching session, declare his/her preference not to discuss a specific issue, by simply stating that they would rather not discuss this issue. The coach agrees to respect this boundary and will not attempt to forward the conversation further along those lines.
The coach will work within the professional ethics and guidelines as designated by both the International Coaching Federation (see www.coachfederation.org). Copies of the ethical guidelines are available on the websites. All information about the coach / client relationship will remain strictly confidential except in very rare circumstances where decreed by law; ie. where the court might issue a subpoena for the file or information.
If you wish for me as your coach to speak to someone outside our interactions, then you will need to provide written permission for me to do so. Exceptions to confidentiality of course relate to circumstances such as intent to seriously harm yourself or someone else, child or elder abuse. Otherwise, your privacy will be protected.
It is also important to note that in some situations, it is important to be aware of the use of technology in that for some clients, there is a risk in using certain media such as the internet, mobile phones and video chat. If you use these to communicate with me, then I will assume that it is appropriate to continue to do so in my interactions with you.
Our signatures on this agreement indicate full understanding of and agreement with the information outlined above.
Executive Health and Wellness Coach
Continuing Coaching Accreditation
In order to accrue continuing accreditation as an executive health and wellness coach, the International Coach Federation (ICF) which the international accrediting body for coaching, has a policy of verifying that coaching has been conducted. As such, they may ask for the contact information (email and/or phone number) of clients in order to verify the claim that I have provided you with professional coaching services. If the ICF choses to verify my hourly claims of coaching, you would need to be willing to verify that you have been provided professional coaching services. If you are willing to have your contact information (email and/or phone) provided to ICF for this purpose please sign below that you are in agreement that this could occur.
Coaching Client Date
Executive Health and Wellness Coach Date