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Consent Life Coaching Consent Form

Informed Consent Client Form

Life Coaching Agreement
1. Life coaching is not currently a regulated industry in the state of South Carolina. It will be solely the
responsibility of the client to determine the effectiveness of the services rendered and the competency of
the coach.
2. Life coaching is not psychotherapy or counseling. Life coaching does not address mental disorders as
defined by the American Psychiatric Association. Your life coaching sessions are not a substitute for
counseling, psychotherapy, mental health care or substance abuse treatment. Psychotherapy is a
healthcare service, and its primary focus is to identify, diagnose and treat nervous and mental

3. Life coaching assumes the mental health of the client. Life coaching is a collaborative process that is
present and future oriented. It is action oriented; solution focused and encourages change. It involves
accountability and commitment to growth through increased competence, commitment, and confidence.
4. As the client, you set the agenda for these sessions and your success will largely depend upon your
willingness to define goals and try new approaches. You can expect me, as your life coach, to be honest
and direct, asking straightforward questions and offering challenging techniques to help you keep moving
Confidentiality is an important element of the coaching process. Your identity and ongoing work will be kept strictly
confidential. I will only release information about our work with your written permission, or if I am required by court
order. The following exceptions will apply:
1. There are a broad range of events that are reportable under child protection statutes. Physical or sexual
abuse of a child will be reported to Child Protective Services. When the victim of child abuse is over age
18, I am not legally mandated to report it unless I believe that there are minors still living with the abuser
who may be in danger of being abused. Elder abuse is also required to be reported to the appropriate
2. If you are at imminent risk to yourself or someone else or make threats of imminent violence against
another person, I will take appropriate action.

Fees, Payment Schedule, and Services
1. You agree that our life coaching session will take place at least twice per month, in which ever manner
you prefer (via in person, by phone, or internet). Each appointment will last for 60 minutes, and the fee is
$197. The payment is due at the start of each session. Note that there is no insurance coverage for these
2. I request that you provide at least a 24-hour notice if you need to cancel or reschedule your
appointment, otherwise you will be charged for the session in full.

Acknowledgment and Release of Liability
By signing this disclosure and consent statement, I acknowledge that I understand the above information. I agree to
hold harmless Lorraine Language, LLC and my life coach from all liabilities and claims which may arise because of
my participation in life coaching.

Thanks for submitting!

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