Please read the following form and sign it below. Sessions cannot begin until a client has signed this agreement with Rugged Weeds. Thank you. Full Name(*) Invalid Input Your name in this format - First Name, Last Name Email(*) Invalid Input A personal email address to which this form will be sent, once submitted in agreement of the terms below. Phone(*) Invalid Input Please provide your preferred phone number at which you can be safely reached for coaching sessions. Please use this format: 555-555-5555. This is the number we will use for phone consultations. Address(*) Invalid Input Provide a complete street and mailing address Choose Service(*) Choose ServiceEmpathic ListeningLife Coaching Invalid Input Please select the service you wish to receive. For pricing of services, please see the page Sessions under the Coaching Menu. Initial Term(*) Initial Term1 session1 month2 months3 months4 months5 months6 months Invalid Input For your initial sessions, please select for how long a period you would like to obtain coaching or empathic listening. Preferred coaching start date(*) Invalid Input Please select your preferred start date. When you select the date, it will populate the field above the calendar. Rugged Weeds will attempt to meet your preferred selection, but cannot guarantee it. Note that the booking calendar is at Bookings Ground Rules: The client is ready to receive the coaching or empathic listening call at the scheduled time. The client pays fees in advance. As a client, I understand and agree that I am fully responsible for my physical, mental, and emotional well-being during my sessions, including my choices and decisions. I am aware that I can choose to discontinue sessions at any time, and that my coach/empathic listener may also discontinue services at any time. I understand that “coaching” is a professional, client-centered relationship, that I have with my coach. This relationship is designed to facilitate the creation/development of personal, professional, or business goals, and to develop and carry out a strategy/plan for achieving those goals. I understand that “empathic listening” is a professional, client-centered relationship, that I have with my Listener. This relationship is designed to actively listen to the needs of the client. As with coaching, I acknowledge that Rugged Weeds make no guarantee regarding specific outcomes or results in this process. While Rugged Weeds will endeavour to assist the client in addressing matters raised during sessions, Rugged Weeds is not responsible for outcomes. I understand that coaching is a comprehensive process that may involve all areas of my life, including work, finances, health, relationships, education, and recreation. I acknowledge that deciding how to handle these issues, incorporating coaching into these areas, and implementing my choices are exclusively my responsibility. I understand that coaching and empathic listening does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association. I understand that coaching and emphathic listening is not a substitute for therapy, and I will not use it in place of any form of diagnosis, treatment, or therapy. I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with them regarding the advisability of working with a coach, and that this person is aware of my decision to proceed with the coaching and/or empathic listening relationship. I understand that information shared with Rugged Weeds will be treated as confidential by Rugged Weeds unless I state otherwise, in writing, except as required by law. The coach/Listener and client will disclose any conflicts of interest within their relationship. I understand that certain topics may be anonymously and hypothetically shared with other coaching professionals for training or consultation purposes. After termination of services, the confidentiality agreement will remain intact. I understand that coaching and empathic listening is not to be used as a substitute for professional advice by legal, medical, financial, business, spiritual or other qualified professionals. I will seek independent professional guidance for legal, medical, financial, business, spiritual, or other matters. 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 understand that all services require payment in full prior to the first paid session (not including free 30-minute consultation). A one-month payment is required initially for a series of coaching sessions. By selecting the 'Yes' checkbox below and submitting this form, it constitutes an electronic record of agreement. Please make sure you have read the Terms & Conditions as well as our Privacy Agreement. A copy will be sent via email to the client, as well as to Rugged Weeds. I have read and agree with the contents of this form and the Terms & Conditions and Privacy Policy(*) I have read and agree with the contents of this form and the Terms & Conditions and Privacy PolicyAgree Invalid Input Are you a human?(*) Refresh Invalid Input SUBMIT
Please read the following form and sign it below. Sessions cannot begin until a client has signed this agreement with Rugged Weeds. Thank you.
Your name in this format - First Name, Last Name
A personal email address to which this form will be sent, once submitted in agreement of the terms below.
Please provide your preferred phone number at which you can be safely reached for coaching sessions. Please use this format: 555-555-5555. This is the number we will use for phone consultations.
Provide a complete street and mailing address
Empathic Listening
Life Coaching
Please select the service you wish to receive. For pricing of services, please see the page Sessions under the Coaching Menu.
For your initial sessions, please select for how long a period you would like to obtain coaching or empathic listening.
Please select your preferred start date. When you select the date, it will populate the field above the calendar. Rugged Weeds will attempt to meet your preferred selection, but cannot guarantee it. Note that the booking calendar is at Bookings
By selecting the 'Yes' checkbox below and submitting this form, it constitutes an electronic record of agreement. Please make sure you have read the Terms & Conditions as well as our Privacy Agreement. A copy will be sent via email to the client, as well as to Rugged Weeds.
