Informed Consent for Mindfulness/Meditation Series Coaching

The mindfulness and meditation series led by Mikki Pugh is not considered psychotherapy. The group falls under the umbrella of coaching, as Mikki will be stepping away from her role as a licensed therapist, and into her role of a meditation coach.

 Description of Coaching: Coaching is a partnership (defined as an alliance, not a legal business partnership) between the Coach and the Client in a thought-provoking and creative process that inspires the client to maximize personal and professional potential. It is designed to facilitate the creation/development of personal, professional or business goals and to develop and carry out a strategy/plan for achieving those goals.

 Coach-Client Relationship

A.    Client is solely responsible for creating and implementing their own physical, mental and emotional well-being, decisions, choices, actions and results arising out of or resulting from the coaching relationship and their coaching calls and interactions with the Coach. As such, the Client agrees that the Coach is not and will not be liable or responsible for any actions or inaction, or for any direct or in direct result of any services provided by the Coach. Client understands coaching is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease.

B.    Client further acknowledges that they may terminate or discontinue the coaching relationship at any time.

C.    Client acknowledges that coaching is a comprehensive process that may involve different areas of the client’s life, including work, finances, health, relationships, education and recreation. The Client agrees that deciding how to handle these issues, incorporate coaching principles into those areas and implementing choices is exclusively the Client’s responsibility.

D.    Client acknowledges that coaching does not involve the diagnosis or treatment of mental health disorders as defined by the American Psychiatric Association and that coaching is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance use treatment, or other professional advice by legal, medical or other qualified professionals and that it is the Client’s exclusive responsibility to seek such independent professional guidance as needed. If Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider of the nature and extent of the coaching relationship agreed upon by the Client and the Coach.

E.     The Client understands that in order to enhance the coaching relationship, the Client agrees to communicate honestly, be open to feedback and assistance and to create the time and energy to participate fully in the program.

F.     The Client understands that although Mikki Pugh is a Licensed Independent Social Worker & Therapist, she is not using her license for the services rendered, she is not presenting herself as a therapist to the Client, and she is not providing psychotherapy to the Client.

 Services

All services will take place via Zoom unless otherwise specified and agreed upon by coach & client.

 Schedule and Fees

The mindfulness and meditation series is $100 for four sessions total, unless an otherwise agreed upon sliding scale fee has been discussed.

 Confidentiality

This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Coach as part of this relationship, is bound by the principles of confidentiality. However, please be aware that the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and thus communications are not subject to the protection of any legally recognized privilege. The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent. Confidential Information does not include information that:

(a) the Coach is required by statute, lawfully issued subpoena, or by court order to disclose

(b) is disclosed to the Coach and as a result of such disclosure the Coach reasonably believes there tobe an imminent or likely risk of danger or harm to the Client or others.

The Client also acknowledges his or her continuing obligation to raise any confidentiality questions or concerns with the Coach in a timely manner.

 Cancellation Policy

The sessions are paid for in advance of the four part series. If cancellation occurs, the client cannot be refunded for the individual session.

 Termination

Either the Client or the Coach may terminate this Agreement at any time. Client agrees to compensate the Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship.

 Limited Liability

Except as expressly provided in this Agreement, the Coach makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the coaching services negotiated, agreed upon and rendered. In no event shall the Coach be liable to the Client for any indirect, consequential or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the  amount actually paid by the Client to the Coach under this Agreement for all coaching services rendered through and including the termination date.

 Entire Agreement

This document reflects the entire agreement between the Coach and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented exception writing signed by both the Coach and the Client. By purchasing the workshop, you consent to the outlined document.