Coaching Consent Form Submission
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Consent Form
Please fill out the fields below. We promise it's not long, we just need to get some basic information. Once complete, click the add-to-cart button.
CLIENT INFORMATION
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Please click on the calendar to choose your date of birth.
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POLICIES & AGREEMENT
Please read the following office policies and agreements that are offered to support our work together. The goal is to have minimal interruptions in your program as well as respecting the commitment we both make to your process. Should you have any questions about any policy, please feel free to discuss them with me. By working together, we can establish a rewarding mentor - mentee relationship.
BENEFITS, RISKS AND ALTERNATIVES TO TREATMENT
Most people benefit from psychotherapy, coaching or spiritual guidance work. Success can vary depending on particular problems, desires and the uniqueness of each person. Coaching, Sself-exploration, gaining understanding, finding ways of working with your inner life, understanding your dreams, dealing with challenges and complexes, as well as learning new skills, are helpful and contribute to change.
CREDIT CARD AUTHORIZATION FORM + BILLING POLICY
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(as it appears on card)
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3 digits on back of card
- Your credit or debit card will be charged in the case of a delinquent balance (15 days after an account statement requesting amount due has been sent).
There will be a 4% convenience fee.
- I understand and accept all of the terms regarding this billing policy.
- I give my permission for Joanna Intara, to bill my credit card for services rendered, and where payment is due.
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COACHING/MENTORING/SPIRITUAL GUIDANCE V. PSYCHOTHERAPY
Joanna Intara, M.A., L.M.F.T. (38453), is trained as a Psychotherapist and a Mentor/Coach/Spiritual Guide. If your work with her as a psychotherapist requires coaching work, she and you will discuss to make an appropriate referral for your situation. Coaching, Spiritual Guidance and Psychotherapy work are different work modalities.
The services to be provided by the coach to the client are coaching or tele-coaching, as designed jointly with the client. Coaching, which is not advice, therapy or counseling, may address specific personal projects, business successes, or general conditions in the client’s life or profession.
Upon completion of the 6 months, coaching will convert to a month-to-month basis. The fee for the initial 6 months is $4,542.90. The client and coach agree to provide each other with fourteen-day notice in the event either wishes to cancel services.
MENTORING/COACHING PROGRAM (ONLINE OR IN PERSON)
I am committing to enrolling in a coaching program with Joanna Intara.
The length of the program is six months and includes 3 one hour sessions, quick question messenger support, M-F, 9 - 5 PST time, one hour tech support per month, and access to the private FB group Hot Sex, Love and Closeness.
Throughout the working relationship, the coach will engage in direct and personal conversations. The client can count on the coach to be honest and straightforward in asking questions and making requests. The client understands that only the client can grant the power of the coaching relationship, and the client agrees to do just that: have the coaching relationship be powerful. If the client believes the coaching is not working as desired, the client will communicate that belief and take action to return the power to the coaching relationship.
Coach responds to client inquiries within 48 hours during BUSINESS DAYS, but reserves the right to extend the deadline for longer copy/content/projects requring additional review time. Coach will not be available on Saturdays or Sundays.
Additional hours of tech support are available at a rate of $75 per hour.
Payment is due today to enroll at offer price.
Any fees not paid by 5 days after monthly payment (if recurring) date are subject to a 5% late fee.
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for any lack of committed action or other difficulties due to not following guidance on recommendations.
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Cancellation and Rescheduling
Showing up for your Intensives and Coaching Calls is very important because it shows commitment to yourself and the work and respect of both your time and my time so I have a very firm cancellation policy. If you need to cancel the Intensives or any Coaching Call for any reason, you must do so at least 48 hours in advance by sending an e-mail to joanna@besoulfulfilled.com. If you cancel or need to reschedule your Intensives, it must be rescheduled within 2 months of the original date, or it is forfeited. If you need to cancel or reschedule a Coaching Call without providing at least 48 hours advance notice, it will be considered forfeited and there will be no opportunity to reschedule it. If a true emergency occurs, please email or call me immediately, and at my sole discretion, I will determine whether the Intensives or a Coaching Call may be rescheduled; otherwise, it is forfeited.
Missed Payment
In the event that there is a problem with the payment transaction or method, you will be notified by e-mail and then have a 72 hour grace period to make the payment following the due date, whether paying in full or by installment, otherwise the Program will be put on hold. If no payment is made within the 72 hour grace period, the Program will be automatically terminated and no refund will be provided.
Refund Policy
I want you to be happy with your Program. If for some reason you are not satisfied and wish to stop the Program at any time, and because I will have invested considerable time and effort in your program, if you decide to withdraw for any reason whatsoever, you still will remain fully responsible for the full cost of the program, and no refund will be provided.
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Intellectual Property Rights
I retain all ownership rights to the materials provided to you through your participation in the Program. The copyrighted and original materials shall be provided to you for your individual use only and with a single-user license. You are not authorized to share, copy, distribute, or otherwise disseminate any materials received from us electronically or otherwise without my prior written consent. All intellectual property, including the copyrighted Program materials, shall remain my sole property and no license to sell or distribute or materials is granted or implied. You agree not to reproduce, duplicate, copy, sell, trade, resell or exploit for any commercial or personal purposes, any portion of the Program, including any of the Program materials. I also agree that you retain ownership of all materials you share with me throughout the Program. They will be considered your own original materials that I agree not to reproduce, duplicate, copy, sell, trade, resell or exploit for any commercial or personal purposes, any portion of the your program, including any of your own program materials.
Other Important Terms
Termination
Either of us may terminate this Agreement with 72 hours written notice to the other. E-mail notification is permissible and sufficient. Please note that I reserve the right to terminate this Agreement if you repeatedly miss payments. I also reserve the right to terminate this Agreement if you miss your Intensives, or any of your Coaching Calls without providing proper notice. All terms of this Agreement, including all Investment, Refund Policy, and Intellectual Property terms as written above, will still apply even after termination by either of us.
Notice
All correspondence or notice required regarding the Program should be made to me at joanna@besoulfulfilled.com and to you at the e-mail address you provided during your enrollment in the Program. Should your e-mail address or contact information change at any time throughout the course of the Program, it is your responsibility to provide your new contact information to me within 72 hours of any such change.
Entire Agreement, Assignment, Survivability and Waiver
This Agreement contains our entire agreement. This Agreement may be modified or amended at any time if the amendment is made in writing and is signed by both of us. You may not assign your rights or obligations under this Agreement to anyone else. In the event that any part of this Agreement is deemed invalid or unenforceable, it shall not affect the validity or enforceability of any of the remaining portions of the Agreement which shall be severed and remain in full force. The failure to enforce any provision of this Agreement shall not be construed as a waiver or limitation of the right to later enforce and compel strict compliance with every part of this Agreement.
Governing Law
This Agreement shall be construed according to the laws of the State of California and all laws and regulations of Petaluma, California.
Dispute Resolution
It is hoped that should we ever have any differences, we could be able to work them out through a phone conversation or e-mail correspondence. However, should a dispute ever arise between us, we agree now that we will submit to binding arbitration before a single arbitrator, selected jointly, in accordance with the American Arbitration Association Rules. Prior to seeking arbitration, you must submit your complaint to me with full details about your dissatisfaction with your Program via e-mail at joanna@besoulfulfilled.com. You understand and agree now that the only remedy that can be awarded to you through arbitration is full refund of your Payment made to date. No award of consequential or of any other type of damages may be granted to you. Any judgment on an arbitrator’s award, if made, is binding and may be entered into any court having the appropriate jurisdiction. By signing this Agreement you are agreeing to a modification of the statute of limitations such that any arbitration must be commenced within one (1) year of the date of the act, omission, or other conduct complained of as submitted by you in e-mail, or shall otherwise be forfeited forever. You also agree that should arbitration take place, it will be held in Petaluma, California and the prevailing party shall be entitled to all reasonable attorney’s fees and costs necessary to enforce the Agreement.
Non-Disparagement
In the event of a dispute between us, you agree to not engage in any direct or indirect conduct or communications, public or private, designed to disparage the Program or me. Coach also agrees not to engage in any conduct or communications, public or private, designed to disparage the Client or her programs. Where requested by law or arbitration, of course, we are not prohibited from sharing our thoughts and opinions as a part of the legal process.
Video Chat – Global Sessions
I’m looking forward to our meeting. Video sessions are provided on ZOOM Video conferencing software which you will need to download onto your phone or computer. I will record your sessions with your consent for your review and implementation wok. I will give you our meeting room number. PLEASE DO NOT CLICK ON THE MEETING ROOM LINK UNTIL THE START OF OUR MEETING AS YOU WILL INTERRUPT THE PRIOR SESSION! I recommend having paper and pen close by for any notes you may wish to take. I also recommend turning of all other devices and having a glass of water available should you feel thirsty.
If we are meeting by FaceTime on iPhone please make sure I have your correct Facetime phone number in advance of our call. Feel free to let me know if you have any further questions.
Looking forward to meeting you and being of service.
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Declaration
I understand that I am working with Joanna Intara for professional coaching at the agreed fee. Professional coaching is distinctly different from counseling, psychotherapy or psychoanalysis and does not deal with the diagnosis or treatment of emotional problems. Since professional coaching does not constitute medical consultation or treatment, health insurance does not apply. These fees may be considered deductible business expenses.
By signing this Agreement and pressing SUBMIT below,, we are both acknowledging that we have read, understand, agree to and accept all of the terms in this Agreement. Your Program will not begin until this signed document has been received.
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