Informed Consent

​

​

Credentials
I am a credentialed and certified professional life coach through the International Coaching Federation with an ACC (associate certified coach) credential, a level one TEAM CBT clinician, and a certified organizational development coach.

Core Values and Statement of Faith: I am committed to honoring Jesus Christ and glorifying God, remaining flexible and responsive to the Holy Spirit in all that I am called to be and do. I am committed to Biblical truths, and to excellence and unity in the delivery of my services.  I acknowledge the complexity of humans as physical, social, psychological, and spiritual beings. The ultimate goal of coaching under the direction of my Christian Faith is to help others move to personal wholeness, interpersonal competence, mental stability, and spiritual maturity. Some interventions may include Christian components; however, I respect your autonomy in choosing whether to participate or not and am sensitive to your wishes.

Coaching Practice: Currently serves individuals and couples 21 years and older.  This may change at any time per the Coach’s discretion. Coaching is a partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client(s) in a thought-provoking and creative process that inspires the client(s) to maximize personal and professional potential. It is designed to facilitate the creation/development of personal, professional, or business goals and develop and carry out a strategy/plan to achieve those goals. Coaching is not always comfortable or straightforward, as difficult emotions are often having to be sorted through for change to occur.  Clients should feel comfortable with me as their coach and be able to ask about whatever is on their minds regarding the process.  
 

Risks and Benefits: Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness, and helplessness, because the process of coaching  often requires discussing the unpleasant aspects of your thoughts and choices.  However, coaching has been shown to have benefits for individuals who undertake it.  Benefits can include coaching, often leading to a significant reduction in feelings of distress, increased satisfaction in inter and intra-personal relationships, greater personal awareness and insight, increased skills for managing stress and situations and life events, and resolutions to specific problems and actualization of goals.  There are no guarantees about what will happen. Coaching requires a very active effort on your part. You will have to work on things we discuss outside of sessions to be most successful. The Client(s) understands that to enhance the coaching relationship, the Client(s) agrees to communicate honestly, be open to feedback and assistance, and create the time and energy to participate fully in the program. The Client(s) agrees it is their responsibility to maintain engagement in their coaching; the Coach will not remind the Client(s) to follow up on session reservations, activities, assignments, or assessments which need to be completed.  The Client(s) recognizes this is a commitment of their time and should allocate the hours required to grow in their personal development.
 

Coach-Client Relationship: Coach agrees to maintain the ethics and standards of behavior established by the International Coach Federation “(ICF)” (Coachfederation.org/ethics ). It is recommended that the Client(s) review the Code of Ethics and the applicable standards of behavior. 
 

Dual Relationships: Exist when a coach interacts with a client(s) in any capacity beyond a coach’s role, such as being the client’s friend, business associate, or teacher of the client’s child.  As your coach, I will not accept you as a client(s) if I feel a significant dual relationship exists.  It is essential to realize that not all dual relationships are unethical or avoidable.  Coaching never involves any dual relationship that impairs the Coach’s objectivity or judgment or can be exploitative. In some areas, dual relationships may be unavoidable.  As your Coach, I will never publicly acknowledge working with you without your permission; in most cases, I will allow you to approach me if you choose to do so.  It is your responsibility to advise me if a dual relationship exists or arises that may become uncomfortable for you in any way.  I will always listen and respond to your feedback and will discontinue the dual relationship if I find it is interfering with, or may interfere, with the effectiveness of our coaching or your welfare. It is important to remember that you are experiencing me only in a professional role. Please understand that invitations to social gatherings or gifts may or may not be accepted.  This is not because I do not care for you; it is based purely on ethical standards to provide you with the very best in coaching services.

​

Confidentiality and Record-Keeping: I am not required to keep records as a certified coaching professional; however, your records are maintained in a secure location, on an external drive, with encryption and password protection.  I keep brief records noting that you were here, your reasons for seeking coaching, the goals, and progress we set, topics we discuss, your medical, and social history, income records, payment service records, and records I may have received from other providers you have given to me with your written permission, as well as billing records or other communications between us including; email, text, or e-sign services. Any records will be retained for no less than six years. Please see confidentiality below for agreement on professional records and how they may be acquired outside of the Coach.
 

Confidentiality: This coaching relationship, as well as all information (documented or verbal) that the Client(s) shares with the Coach as part of this relationship, is bound by the principles of confidentiality outlined in the Code of Ethics. However, please be aware that the Coach-Client(s) relationship is not considered a legally confidential relationship (like the medical and legal professions). It is important that you understand all identifying information is kept confidential, except as those listed below. 
 

Limits of Confidentiality: It is important that you understand the limits of confidentiality. In certain situations, I may be required by law to reveal information obtained during sessions to outside persons or agencies without your permission. This includes the following:

• Confidentiality does not apply to generally known to the public or the client’s industry

• Confidentiality does not apply to information obtained by a third party without breach to the client

• Confidentiality does not apply to cases of suspected abuse/neglect of children or the elderly.

• Confidentiality does not apply to cases of potential harm to self or others.

• Confidentiality does not apply to cases of illegal activity

• Confidentiality may not apply in cases involving legal proceedings affecting the parent-child relationship.

• Confidentiality may not apply to group or marriage coaching clients, secrets will not be maintained by the Coach for marriage or group members purposes.

• Coach may disclose confidential information in proceedings brought by Client against a Coach.

• Coach may disclose independently developed information using only reference to general techniques and practice on social media, website, or podcast. No identifiable information will be revealed outside of gender and general techniques and behaviors.
   

Release of Information for accreditation, continuing education credits
The Coach requires logs to show the engagement of client hours to maintain coaching credentialing and may ask for recordings of sessions to be viewed for continued professional growth prior to the commencement of sessions. That process requires recording video and voice during sessions, the names and contact information of all Client(s) for verification by educational/professional organizations. An individual request will be made to clients on a case-by-case basis.
 

Coaching Plan: The Client is solely responsible for creating and implementing their own physical, mental, and emotional well-being, decisions, choices, actions, and results arising out of or resulting from the coaching relationship and his/her coaching sessions and interactions with the Coach. The Coach cannot guarantee any unlimited positive outcomes for the Client(s).  As such, the Client(s) agrees that the Coach is not and will not be liable or responsible for any actions or inaction or for any direct or indirect result of any services provided by the Coach. Client(s) understands that coaching is not therapy and does not substitute for psychotherapy and does not prevent, cure, or treat any mental disorder or medical disease. At any point, the Coach may refer you to a professional that may provide these services.  If you are currently receiving treatment from a licensed mental health professional, you are required to inform them of our work together, a form will be provided to you.  

Coaching, not Counseling: Client(s) acknowledges that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals. In the event that you feel your mental, physical, or emotional health requires emergency attention or if you have an emotional crisis, you should report to the emergency room of your local hospital and request licensed mental health services. 

Termination: Client(s) further acknowledges they may terminate or discontinue the coaching relationship at any time.  The Client(s) also acknowledges that the Coach may terminate the coaching relationship at any time due to inappropriate, abusive behavior, including cursing, degrading, or attacking the Coach.  The Client(s) also acknowledges that the Coach may terminate the agreement due to repeated absences, owed debt, or any other concerns for ethical boundaries related to the ICF code of ethics.

Appointments: Sessions will ordinarily be 50 minutes in duration, once per week at a time agreed upon.  The Coach is located in the Eastern Time Zone.  The time scheduled for your session is assigned to you and you alone.  You will be given a link to schedule your appointments and are expected to accurately place these on your calendar and provide yourself with alerts and reminders. 
 

Cancellation: Client(s) agrees to the following cancellation policy.  Cancellation of any sessions must be received within 24 hours of scheduled services.  Client(s) agrees to a timely appearance to all sessions. If the client(s) is unable to arrive within 15 minutes past the session beginning time, the client(s) will be charged their session and/or fee.  If the Coach is unable to make the session, Client(s) will be notified before the scheduled appointment time. If for some reason, the Client(s) is unable to find a session date and time that works for their schedule, the Client(s) may email the Coach and request additional dates and times. This is a request and is not a promise of the requested coaching/counseling session time/date.

Professional Fees
All coaching fees are to be paid when services are rendered. Payments must be made by credit card via the invoice provided to you.  If you refuse to pay your debt, I reserve the right to use an attorney or collection agency to secure payment.
 

Payment: Client(s) agrees to the contract terms and will notify the coach if payment type changes. If payments are declined, the Client(s) will be asked for an additional payment form; however, if a different form of payment is not received, a fee of $25.00 will be assessed for every declined credit card. Any delinquent payments exceeding 30 days after the payment due date will suspend all coaching/counseling sessions and services. If Client(s) does not maintain payment on the due date or leaves the program without notice and completion of contract terms, the client(s) will be placed into remediation in a small claims court and agrees to pay all legal fees incurred for Client(s) and Coach.

Raising of fees: Fees will be re-evaluated each calendar year. If yearly evaluations reflect a fee increase, current clients may fulfill their current contract terms. However, subsequent contract terms will reflect a fee increase.  Previous contract terms do not guarantee fees indefinitely. 

Emergency Services
Piper Harris Coaching DOES NOT provide emergency services or an emergency call center. All phone and email messages will be checked daily but are not for use of an emergency. If you have an emergency, call 911.  

 

Contact and Hours of Operation

I am often not immediately available by phone or email. I do not answer my phone or email when I am with clients or otherwise unavailable. At these times, you may leave me a message or email. However, this is not confidential.  I will return your phone call or email in no less than 24 hours; up to 2-4 days.  If you have an emergency, you must call 911 and speak with professionals on the call.  I will make every attempt to inform you of planned absences.
 

Hours of Operation

I will be available to you Monday through Friday from 9 AM to 5 PM Eastern Standard Time. If communication is received after 5 PM EST, I will respond the following business day. If communication is received after 5 PM EST on Friday, you will receive communication the following Monday. 

 

Contact:
Phone: (770) 317-1126

Email: piper@piperharris.net

​

​

​