Intake Forms

Please check which Coaching Service would best serve you:

Welcome to my Coaching Practice. This agreement outlines both our responsibilities in this powerful relationship.

Please read this over and if everything is fine, indicate your agreement and submit at the bottom. Of course, let me know if you have any questions or concerns!

This document and attachments constitute a contract between us (the “AGREEMENT”) and you should read it carefully and raise any questions and concerns that you have before you sign it. The services to be provided by Carla Walker are coaching or tele-coaching as designed jointly with the client. The fee for coaching sessions will be charged at the rate of $395 per 50-minute hour. If I am required to attend meetings outside of my offices, you will pay for all time I spend traveling to the location of such meetings. Fees for coaching sessions must be paid at each session. You must also pay for collateral services within 30 days of billing. Services not paid for in advance will not be provided. You are required to give 48-hour notice if you need to cancel or change the time of an appointment. Otherwise, you will be charged $395 for the session in full. Carla Walker agrees that every effort will be made to reschedule sessions which are cancelled in a timely manner.

Coaching Guidelines:
I have positive expectations for our coaching relationship and you creating the life you want to live. To partner together professionally, I want you to be familiar with the following guidelines.

Terms of Coaching:
I invite you to think of Coaching as a process. Many people create change for themselves in a short time. However, to refine and sustain the change can take several months. Although not binding, I would ask that you expect our Coaching relationship to last at least 3 months.

Fees:
My Coaching fee is payable to Carla’s Counseling, Coaching and Classes. If you pay by credit card, I will charge the day of the session.

Credit Card: (THIS IS MANDATORY and will be used in the event of a missed session or late cancel) Visa/ MasterCard/ Discover/ American Express:

Procedure:
Sessions will with be at the office, Skype or I will call you at a specified time, unless we make other arrangements.

Changes:
If you need to reschedule our appointment, please give 48-hour notice. If you have an emergency or illness, you can reschedule with less than 24-hour notice. If you do not show up for a scheduled time, for any reason, and provide no notice (latest notice can be 15 minutes past scheduled session start time), we will not make up that time. If I need to reschedule, I will give you at least 48 hours’ notice as well, barring an emergency or illness.

I agree to serve as your Coach - to partner with you to identify and achieve your personal and/or professional goals.

As your Coach, I cannot guarantee results. You will create powerful results by having the courage and determination to forward the action in your life.

During the time we spend together in our coaching sessions, I will devote my time, thoughts, and energy to you.

I am a Coach and a psychotherapist.

Coaching & Psychotherapy

In addition to being a coach, I am also a licensed in California with training and experience in diagnosing and treating emotional problems. While there are some similarities between coaching and psychotherapy, they are very different activities and it is important that you understand the differences between them. Psychotherapy is a health care service. This is not true for coaching. Both coaching and psychotherapy utilize knowledge of human behavior, motivation and behavioral change, and interactive counseling techniques. The major differences are in the goals, focus, and level of professional responsibility.

The focus of coaching is development and implementation of strategies to reach client-identified goals of enhanced performance and personal satisfaction. Coaching may address specific personal projects, life balance, job performance and satisfaction, or general conditions in the client's life, business, or profession. Coaching utilizes personal strategic planning, values clarification, brainstorming, motivational counseling, and other counseling techniques.

Confidentiality

As a licensed Marriage and Family Therapist, I am ethically and legally bound to protect the confidentiality of our communications. I will only release information about our work to others with your written permission or in response to a court order. There are some situations in which I am legally obligated to breach confidentiality in order to protect you or others from harm. If I have information that indicates that a child or elderly or disabled person is being abused, I must report that to the appropriate state agency. If a client is an imminent risk to him/herself or makes threats of imminent violence against another, I am required to take protective actions. These situations are quite rare in coaching practices. If such a situation occurs in our relationship, I will make every effort to discuss it with you before taking any action. As you are no doubt aware, it is impossible to protect the confidentiality of information that is transmitted electronically. This is particularly true of e-mail and information stored on computers that are connected to the internet, which do not utilize encryption and other forms of security protection.

As your Coach, I will bring attentive listening, understanding, belief in you and commitment to your success. You can expect me to challenge you, offer fresh perspectives, make requests (including assigning homework), acknowledge your wins, and guarantee utmost confidentiality (to the fullest extent of the law, and so long as I don't fear for your or another's safety) in the powerful, sacred relationship.

Client

I am motivated and committed to taking action on my determined personal and professional goals. I realize that anything less than my intentional full participation will not lead to my success.

I accept full responsibility for myself and any actions I take that might result from Coaching.

I am under the care of a physician and healthy enough to engage in coaching. I agree that ultimately, it is my responsibility that my coach gets paid for the services.

I agree to honor my scheduled session times.

I have read and agree with the Coaching Guidelines and the Coaching Agreement with me in between sessions with a challenge, a success or an inquiry, I will make every attempt to respond to your e-mail within 24 hours, with an email or short phone call at your discretion.

Please Initial Each to Acknowledge

ADDRESS CHANGES

Please advise me if you change your address, telephone number, or place of employment.