The parties agree to engage in the following program (cross out all that apply):
Therapist/Coach will be available to Client via email in between scheduled meetings as defined by the Therapist/Coach.
Therapist/Coach may also be available for additional time, per Client’s request on a prorated basis rate of $330 p/h (for example, reviewing documents, reading or writing reports, engaging in other Client related services outside of appointment hours).
This coaching agreement is valid as at ___/___/_____.
The total package fee is $___________ which equates to $ ____________ per hour.
This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Therapist/Coach as part of this relationship, is bound by the principles of confidentiality set forth in the Code of Ethics.
Confidential Information does not include information that:
The Client acknowledges that the Therapist/Coach has disclosed his/her record retention policy with respect to documents, information and data acquired or shared during the term of the Coach-Client relationship. Such records will be maintained by the Coach in a format of the Coach’s choice (print or digital/electronic) for a period of not less than seven years.
Client agrees that it is the Client’s responsibility to notify the Therapist/Coach 72 hours in advance of the scheduled calls/meetings if the appointment needs to be cancelled. Therapist/Coach will attempt in good faith to reschedule the missed meeting. Where less than 72 hours’ notice is not provided:
Either the Client or the Therapist/Coach may terminate this Agreement at any time with three weeks’ written notice. Client agrees to compensate the Therapist/Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship.
Where less than three weeks’ notice is provided, any appointments scheduled within the following three-week cancellation period will become due and payable in full.
In addition, a termination fee will apply. Packages offer a discount to the standard hourly rate. Such discounts only apply to full packages and only if all sessions are purchased. If packages are terminated, the package price will be void and the standard rate ($330 per hour) will apply to all invoices that have already been charged and will become immediately due and payable. If the Client wishes to sign up instead to a lesser package, the discounted rate of the lesser package will apply to all paid and unpaid sessions.
Example
Client is on the Clearer package which includes 12 hours of sessions and is $282 per session, Client terminates with three weeks’ notice, using a total of six sessions. Clearer package is now void due to termination. Client has a choice of either:
In this example, the cheaper of the two options is to sign up to the lesser package.
Where Client has paid in full up front, the balance will be refunded less the termination fee.
This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns.
Please sign both copies and return one copy of this Client Agreement prior to your next scheduled appointment.
CLIENT
Name: ___________________________________
Address: ___________________________________________________
Signature: ___________________________________ Date: __________
THERAPIST/COACH
Name: ___________________________________
Address: 50/7-9 King Street, Campbelltown 2560 Date: _________
Signature: ___________________________________
I acknowledge the Aboriginal and Torres Strait Islander peoples as the first inhabitants of the nation and the traditional custodians of the lands where we live.
I pay my deepest respects to Elders, past, present and emerging.
Time Line Therapy® is a registered Trademark owned by Tad James
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