Client Intake Form.

client intake form.

Thank you for selecting Transform U, LLC to take you from existing to living. Please take a few moments and fill out the client intake form below. If you have any questions or concerns, please contact Transform U staff. 

ABOUT THE COACHING PROCESS

The International Coach Federation’s definition of coaching quoted in part that is as follows: “Professional Coaching is an ongoing professional relationship that helps people produce extraordinary results in their lives, careers, businesses or organizations. Through the process of coaching, clients deepen their learning, improve their performance, and enhance their quality of life.

 

In each meeting, the client chooses the focus of conversation, while the coach listens and contributes observations and questions. This interaction creates clarity and moves the client into action. Coaching accelerates the client’s progress by providing greater focus and awareness of choice. Coaching concentrates on where clients are now and what they are willing to do to get where they want to be in the future. Coaches recognize that results are a matter of the client’s intentions, choices and actions, supported by the coach’s efforts and application of the coaching process.”

 

RESPONSIBILITIES OF YOUR LIFE COACH

Life Coaches are assigned depending on your situation. The life coach will work with you to resolve the situation that brought you in. All aspects of a person are important and, as such, your life coach will consider spiritual, social, emotional and biological factors when working with you. Your life coach will be honest with you and keep careful, confidential records concerning the directions being pursued in the process.

 

LIABILITY

This agreement is for Coaching, not Psychotherapy. Kimmalla Mitchell, M.A. is working only within the capacities of a Life Coach and will not be held liable for discrepancies. While coaching can work with issues such as identifying and reaching life goals, and changing the behaviors that aren’t working well for you, coaching will not address psychological issues. For issues such as these, Ms. Mitchell will refer you to outside therapist that specializes in pyschotherapy. By giving consent you are agreeing that you understand the difference in these two functions and you will get appropriate professional help for mental health issues if necessary.


TERMINATION OF COACHING
Clients have the right to terminate the coaching relationship at any time. If you choose to terminate the therapeutic relationship, we ask that you participate in a termination session. Transform U reserves the right to terminate the therapeutic relationship under the following conditions:

Lack of progress in the therapeutic process
Noncompliance with the therapeutic process
Excessive cancellations
The coach determines that life coaching is inappropriate for the client's needs
***If the life coach makes the termination decision, we will provide you with references for three other counseling providers to assist your search for a therapist. ***

FEES AND CANCELLATIONS
Coaching sessions are $75.00 (or predetermined amount) per 45 to 50 minute session. All payments must be made online at TransformUNow.org. If you are unable to pay, please discuss this with your life coach. Payment is expected at the time of the service.

In the event you are unable to keep an appointment, 24-hour advance notice of your cancellation is required. Except for emergencies, such as an accident or illness, Transform U will charge $75.00 for a “No Show” or for a cancellation without a 24-hour notice.

CONFIDENTIALITY
Your identity and ongoing work will be kept strictly confidential with the following exceptions:
● Your life coach may consult with other professionals to gain other perspectives and ideas on how to best help you reach your goals. This type of consultation is obtained in a way that maintains complete confidentiality. 
● Disclosure of your records are compelled by law. Life Coaches will first “privilege” (which is your right to deny the release of your records). Your records will only be released with your written permission or if a court denies the assertion of privilege and order the release of records.
● If your life coach determines you are a threat to yourself or others (suicidal or homicidal), there is a duty to warn or disclose and this will be reported to appropriate family members, law enforcement professionals and/or mental health professionals. 
● There are a broad range of events that are reportable under child protection statutes where life coaches have a duty to disclose. Suspicion of physical or sexual abuse of a child will be reported to Child Protective Services. When the victim of child abuse is over the age of 18, life coaches are not legally mandated to report this unless there is reason to believe there are minors still living with the abuser who may be in danger of being abused.
● Your life coach is required to report abusive, neglectful, or exploitative behavior toward an elderly or disabled person. 

CONSENT TO SERVICES
I voluntarily agree to receive services, and authorize the assigned life coach to provide such care, treatment or services as are considered necessary and advisable. I understand that I will participate in the planning of my care, treatment or services, and that I may stop such services through the assigned life coach at any time.

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