Dear Client,

 

I would first like to say welcome! As well, commend you on taking this first step into greater

wellness. I hope you find our time together very worthwhile. I am a Health and

Wellness Coach who uses modalities such as Motivational Interviewing, awareness, descriptive questions, and personal experience to help you achieve your goals.

 

What to Expect

 

During your first session, I will conduct an assessment to get a sense of what brings you to

coaching. Additionally, we will identify what your goals are and develop a plan for our work together. Through collaboration with you, I will use a range of modalities to help you achieve success. Please note that at times we may get onto topics that may feel uncomfortable for you. Do know, you can share as little or as much as you feel comfortable with me.

 

Client Rights

 

You have the right to terminate service whenever you deem necessary

You have the right to decide what you choose to share and discuss

 

Client Confidentiality

 

I am bound by strict confidentiality, where you are concerned.

 

Other than the limitations below, I will not release your name or any information about you without your informed, voluntary, written consent.

 

– Disclosure of harm to yourself

– Disclosure of harm to others

– Suspicion or disclosure of any form of child abuse or neglect. Whether it be your child or the

child of another.

 

Please know that if the above is disclosed, I am morally obligated to report it to the authorities.

 

As a client of Adrean Russell, Wellness Coach, BA, I am at liberty to seek or

continue services with any other health care provider. This consent form is intended to cover the

entire course of our work together.

 

  • I understand that I am free to withdraw my consent and to discontinue participation in services at any time.
  • I understand that a record will be kept of the services provided to me. 
  • This record will be kept confidential and will not be released to others without my consent unless required by law.
  • I understand the limits of confidentiality.
  • I understand that the results are not guaranteed. I also understand that the process of personal growth can be emotionally uncomfortable at times.
  • I accept full responsibility for any fees incurred in my sessions.
  • I understand that charges are to be paid at the time of the visit unless previously arranged before my scheduled appointment.

I also understand that the Cancellation policy requires me to cancel and/or reschedule a

booked appointment 24 hours before a given, scheduled appointment. Cancellations with

less than 24 hours’ notice will incur a charge of 50% of the coaching session fee that

must be paid before the next session.