Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthdate

MM

DD

YYYY

Disclosure of Past or Current Relevant Treatments *

I am currently in treatment/consulting with the following individuals (check all that apply):

Therapist

Psychotherapist

Nutritionist

Medical Practitioner

Other coaching

Mentoring

None of the above

If my coach and my other practitioners wish to share information or request my records, I will sign a separate document indicating exactly what type of information will be permitted to be shared. *

First Name

Last Name

I agree to inform the practitioners listed above that I am working with a Life Coach, and that our work is coaching, not therapy. I understand and agree that my coach does not represent herself as anything other than an Life/Equus Coach. *

I agree

Not Applicable

Statement of Intent *

All coaching services provided by Abby Cameron are intended to uplift and motivate a client. Life coaching is in no way meant to replace any psychological care, and if those services are needed the client will find them on their own. Abby does not offer advice, psychotherapy, or counseling. All records and information will be kept confidential except where required by law to disclose the information. From time to time, information may be shared with other coaches with personal details omitted for the purpose of continuing education. The proper authorities will be contacted, and the exceptions to confidentiality will be made for any of the following reasons: If at any point during coaching abuse of a child(ren) or the elderly is discovered. If at any point during coaching I determine you intend to hurt another individual and I strongly feel you will act on that threat. If at any point during coaching I determine that you are a threat to yourself and I strongly feel you will act on threat.

Agree

Terms and Conditions *

Payment & Refund Policy Payment is required in full (or via an approved payment plan) before the first session. Payments are non-refundable once coaching has begun. If a client wishes to discontinue coaching, refunds will not be issued for unused sessions. For payment plans, all payments must be made on time. Failure to complete payments may result in suspension of services. Scheduling & Cancellations Sessions are scheduled in advance. Clients must provide at least 24 hours' notice to reschedule a session. Missed sessions without proper notice will be forfeited. If the coach needs to reschedule, every effort will be made to provide ample notice and offer an alternative time. Late Arrival Policy Sessions will start and end on time. If the client is late, the session will still end at the scheduled time. If the client is more than 15 minutes late without notice, the session is considered forfeited. Commitment & Expiry Coaching packages must be used within 6 months from the start date. Unused sessions will expire after this period. Consistent participation is encouraged for best results, and clients should aim to schedule sessions at regular intervals. Confidentiality & Privacy All coaching sessions are confidential. Information shared will not be disclosed unless required by law. Client data is stored securely and will not be shared with third parties without written consent. Liability Disclaimer Coaching is a collaborative process, but results are not guaranteed. The client is responsible for their own decisions, actions, and outcomes. The coach is not liable for any direct or indirect consequences resulting from coaching sessions. Intellectual Property Any materials, exercises, or resources provided during coaching are for the client’s personal use only and may not be copied, shared, or resold. Termination Clause Either party may terminate the coaching agreement with written notice. If the coach terminates the agreement, the client will be refunded for unused sessions. If the client terminates, no refunds will be issued.

Agree