Client Agreement Form
*A .pdf version of the Client Agreement Form will be customized and emailed after our initial consultation. The following is a summary for you to preview. Let me know if you have questions or would like further clarification.
Client Agreement Form (Sample Only)
Fee/Payments:
$ per session
$ for the total series or project
$ per month
Other Details:
Sponsoring entity and details (if applicable): ______________________________________________________________________________________________________________________________________
Session payments can be made by debit/credit card. An invoice will be emailed to you following each session unless otherwise arranged.
Session Summary:
Day:______________ Time: ____________________
Number per month: ________________________
Session Type: __ Phone __ Zoom __ Other
Session Duration (most often 60 mins.): _____
Basic Details:
Determine session time/format. Sessions can be in-person, by phone or Zoom depending on the comfort level of each client.
Together we will set the agenda based on what you want to work toward.
If the need arises to cancel/reschedule a session, please provide at least 24-hour notice to avoid being charged for the session
Our sessions together are a two-way relationship, and your feedback is always appreciated.
Client Agreements:
I understand that sessions will be facilitated by Dusty Johnson, and I will make every effort to be ready for the session on time.
As a client, I understand that I am fully responsible for my physical, mental, and emotional well-being during sessions, including my decisions. I am aware that I can discontinue sessions at any time.
I understand that payment is due on the day of each session unless otherwise arranged.
I understand that “coaching” or “spiritual direction” is a professional-client relationship and aims to facilitate my personal, professional, and or spiritual goals.
I understand that sessions may include a comprehensive process involving all areas of my life. I acknowledge that it is my responsibility as to how I incorporate my growth and awareness in these specific areas.
I understand that sessions will not include diagnosis or treatment for mental disorders as defined by the American Psychiatric Association. I will not use spiritual direction or coaching as a substitute for professional mental health diagnosis, treatment, or therapy. I will consult with my mental health care provider regarding the advisability of working with a spiritual director/coach.
I understand that my conversations are confidential, and will not shared with others without my permission.
I understand that sessions are not a substitute for professional advice by legal, medical, financial, business, or other qualified professionals. I will seek independent professional guidance for these and other matters should the need arise and understand that my decisions and actions are my sole responsibility.
I have read and understand the agreements outlined above. I will email or bring a signed copy of this Client Agreement Form prior to the first session.
Date:
Client Signature: