Commitment to Your Growth and Well-Being

This section outlines James Fitzgerald Therapy PLLC’s coaching services agreement and informed consent contract.

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Informed Consent and Coaching Agreement

Coaching Services to be Provided:

This informed consent to Coaching services (hereinafter “Agreement”), is made effective by and between James Fitzgerald, MS, hereinafter referred to as “Coach” and you the client, hereinafter referred to as “Client”.

RECITALS:

WHEREAS, Client is desirous of implementing Coaching services into the Client’s health care and wellness, as discussed more fully below;

WHEREAS, the coach is a licensed, educated, and skilled psychotherapist and mental health counselor; and capable in the areas Client needs and would like to provide Coaching services to the Client;

NOW, therefore, in consideration of the promises and covenants contained herein, the receipt and sufficiency of which is acknowledged, the Parties do hereby agree as follows:

Article 1 – SCOPE:

This Agreement sets forth the terms and conditions whereby Coach agrees to provide professional coaching services (as described below). The coach will be engaged for the limited purpose of providing the coaching services offered through the coach’s client management system “Therapy Portal” and the client engagement system “Quenza” to the Client.

Article 2 – NO EMPLOYMENT:

Neither party is by virtue of this Agreement authorized as an agent, employee, or legal representative of the other. Neither party shall have the power to control the activities and operations of the other and its status at all times will continue to be that of an independent contractor relationship. Client may allow Coach to act as an authorized legal representative in certain circumstances under the terms of this Agreement, but such circumstances will be agreed to by both Parties in writing beforehand.

Article 3 – COACHING TERMS:

A coaching relationship between two Parties is essentially a relationship whereby the Coach assists the Client in meeting the Client’s potential within the areas the coaching relationship is meant to focus on. Client hereby acknowledges and agrees:

a.) Client is solely and exclusively responsible for the choices that Client makes with regard to this coaching relationship, as well as the Coach’s recommendations and input; b.) Client is solely and exclusively responsible for Client’s own mental health, physical health, business decisions, and any other actions or inaction Client chooses to take; c.) Coach is not liable for any result or non-result or any consequences which may come about due to Client’s relationship with Coach; d.) Coaching is not professional psychotherapy or counseling. Coaching assignments and sessions are not therapy or medical services and Client is responsible for procuring these services at Client’s own will and discretion if needed.

Article 4 – DESCRIPTION OF SERVICES:

The Client hereby engages the Coach, and the Coach accepts such engagement to provide coaching services for the Client (hereinafter, the “Services”). The Services include the Pathways and Activities provided on Quenza and the individual Coaching sessions to be held as agreed by the Client and the Coach. Coach and Client will use email, text, and the chat feature in Quenza to communicate, and Zoom for virtual meetings throughout the coaching relationship. Coach may agree in a separate, written document to expand the scope of Services to include additional tasks. Such written document may be informal, such as an email, and will include additional fees, as applicable.

The coach is currently using a copyright protected health and wellness life coaching program titled “Strengthening Your Conscious Self” which specifically aims to improve quality of life satisfaction scores in the following domains of a person’s health and wellness.

• Physical domain: Biology, Nutrition, Genetics, Kinetics, Anatomy, and Neurology
• Mental domain: intelligence, intellect, capacity, ability
• Psychological domain: emotions, conscience, consciousness, morality, values, beliefs
• Shadow domain: suppressed beliefs, values, emotions, memories, pain, and suffering
• Spiritual domain: belonging, connection, meaning, purpose, hope, faith, and optimism
• Gender domain: roles, norms, expression, identity, and presentation
• Sex domain: reproductive system, characteristics, sexual orientation, and sexuality
• Interpersonal domain: family, friends, coworkers, subordinates, superiors, dynamics
• Social domain: community, events, organizations, hobbies, interests, activities
• Academic domain: primary, secondary, post-secondary, doctoral, lifelong learning
• Occupational domain: work ethic, values, contribution, fulfillment, enjoyment
• Financial domain: standard of living, financial literacy, security, safety, retirement
• Cultural domain: social systems, politics, religion, ethnicity, race, identity, class
• Environmental domain: climate, air, water, workplace, housing, support systems

The Coach draws on and shares the knowledge and wisdom of the sciences in many broad areas of study, including but not limited to:

• Anatomy and Physiology
• Biology
• Neuroscience
• Nutritional Science
• Anthropology
• Sociology
• Theology
• Spirituality
• Alternative Health Practices (Reiki, Massage, Acupuncture)
• Holistic Mind Body Practices (Yoga, Tai Chi, Qi Gong)
• Psychiatry
• Psychology
• Sports Psychology
• Organizational Psychology
• Political Science
• Environmental Science
• Climate Science
• Philosophy
• Critical Thinking
• Positive Psychology
• Character Strengths and Virtues
• Values in Action
• Professional Ethics

In addition, the coach, from time to time, may use therapeutic interventions integrated from evidence-based psychotherapy models and theories, with a less formal and less clinical service delivery.

• Mindfulness Based Stress Reduction
• Cognitive Behavioral Therapy
• Emotional Focused Therapy
• Dialectical Behavior Therapy
• Compassion Focused Therapy
• Motivational Enhancement Therapy
• Acceptance and Commitment Therapy
• Feminist Theory
• Narrative Therapy
• Exploring Your Own System with IFS and Parts Work

The Client agrees to complete any homework assigned by the Coach in between sessions, because the knowledge gained from the assignments, and information shared in the handouts, is necessary, to apply that knowledge and any new skills learned, in the Client’s life.

Article 5 – WARRANTIES:

Coach represents and warrants that Coach has the knowledge, skills, and experience necessary to provide the Services. Coach agrees that during the term of this Agreement, Coach will agree to provide the Services at the request of the Client. Coach represents and warrants that Coach does not maintain a specific certification. Coach is licensed as a rostered psychotherapist, and has the skills necessary to fulfill Coaching responsibility. Coach acknowledges and agrees that certification is not a material inducement for the Client to enter this Agreement.

Article 6 – NONEXCLUSIVITY:

Coach is engaged in private practice as a psychotherapist in Vermont. This does not place Coach in a conflict of interest with the Client. Client hereby explicitly acknowledges and agrees that Coach is engaged in practice as a psychotherapist which does not affect the Coaching relationship. Coach and client agree that the coaching relationship and work does not constitute therapy.

Article 7 – AVAILABILITY & SCHEDULE:

Coach and Client agree to virtual coaching meetings on a weekly recurring basis for Coaching services. The length of each coaching meeting shall be 55 minutes. The Parties in an exclusive Coaching relationship agree to 52 total Coaching sessions per year under this Agreement. Client is responsible for those fees incurred during Coaching sessions. Coach and Client may agree to a change of the schedule between them, through an additional written document. Coach and Client may also agree to adjust each meeting on a per meeting basis.

Article 8 – HOLIDAYS: Coach will be unavailable on the following holidays:

• MLK Day
• Valentine’s Day
• St Patrick’s Day
• President’s Days
• Memorial Day
• Independence Day
• Labor Day
• Indigenous People’s Day
• Thanksgiving
• Christmas Eve/Day
• New-Year Eve/Day

Article 9 – FEES AND EXPENSES:

Client will be billed and charged weekly through the Therapy Portal payment invoicing and processing system, with account statements to be sent on a monthly basis. The frequency of sessions depends on factors like: scheduling, level of need, and others. The service rate is $120.00 per weekly session (1 hour) to be billed to client upon completion of each session. The hourly rate for other Services, forms of communication, such as meetings, calls, emails, etc. will be $75.00. Payment will be made within 7 days after receipt of the invoice and/or account statement. For past due invoices more than 30 days late, a late fee of $25.00 will apply. There is an option to set up autopay. Payment for the previous week is expected before the current session, unless other arrangements have been made. If the balance accrues to more than 2 sessions, services will not be scheduled until payment has been made. The Services will begin at the execution of this Agreement, and in some instances on the date of the first session.

Article 10 – CANCELLATION & RESCHEDULE POLICY:

Client or Coach may, from time to time, need to cancel or reschedule any of the coaching meetings. If Coach is responsible for the reschedule, Coach will become available to Client at the soonest possible opportunity within ten (10) business days. If Client is responsible for the cancellation or reschedule, Client agrees to notify Coach no less than 24 hours prior to the scheduled meeting. If Client cancels or reschedules within the 24-hour period, Client agrees to pay $75.00, if requested by Coach (at Coach’s sole and exclusive discretion). The Parties will then attempt to reschedule the meeting in good faith.

Article 11 – REFUND POLICY:

Coach makes no claims about the effectiveness of Coaching methods and interventions. Client accepts that the Coach does not provide refunds.

Article 12 – RECORD RETENTION POLICY:

Coach and Client hereby acknowledge and agree that they have specifically discussed Coach’s record retention policy. Coach will maintain communications, documents, information, and notes related to Client, in a manner most convenient for Coach.

Article 13 – TAXES:

Client and Coach shall each be solely responsible for all of their federal, state, and local taxes.

Article 14 – RESPONSE TIME:

Client agrees to respond to Coach no later than 2 business days after being reached out to for communication. In the event of an emergency or other similar conflict, Coach will give the Client as much notice as possible if there is the possibility of interruption to the Services, whether that interruption is temporary or long-term.

Article 15 – CONFIDENTIALITY:

The existence of this coaching relationship, as well as any information that Coach receives from Client, are to be fully and completely confidential under the terms of this Agreement. Client hereby acknowledges and agrees, however, that a Coach-Client relationship is not considered a legally confidential relationship and therefore communications between Coach and Client are not subject to any legal confidentiality requirement or privilege. Coach will not, however, disclose Client’s name or any of Client’s information without Client’s consent, unless subject to a legal requirement, such as a court order, subpoena, or law enforcement inquiry. It will be the Client’s responsibility to address any confidentiality issues with the Coach.

Confidential information under this Agreement shall specifically not include the following categories: (1) information that is generally known to the public or known to Client’s specific industry, (2) information freely given by Client to any third-party; (3) information received by Coach from any source that is not Client; (4) information in Coach’s possession prior to this contractual Agreement; (5) information developed independently by the Coach; (6) information which is received by the Coach from the Client but that may imminently harm the Client or another individual; or (7) information about any illegal activity.

For Client in a Coaching relationship with the Coach, the rules regarding confidentiality are by default, subject to the ethical standards of counseling practice. Client acknowledges that Coach is a mandated reporter and is obligated to report abuse, property damage, and/or threats to property and individuals.

Article 16 – TERMINATION:

This Agreement will terminate one year from the date signed. Coaching agreement may also terminate after an agreed-upon number of coaching meetings have been completed. The Parties may choose to renew this Agreement, with all of its terms and conditions, by providing notice before the end of this current agreement. If the Parties agree, a new Agreement will be drafted and signed. The Parties may also terminate this Agreement prior to its natural expiration under certain circumstances. This Agreement may be immediately terminated in the event that there is a breach of the terms by either Party. For a material breach, the Parties are required to give notice, in writing, specifying what the breach was, but do not have to give advance notice to terminate the Agreement. This agreement will also immediately terminate upon the death of the Coach or Client, the inability of the Coach to perform the Services because of a sudden and medically-documented physical or mental disability, the liquidation, dissolution or discontinuance of the business of the Coach in any manner, or the filing of any petition by or against the Client or Coach under federal or state bankruptcy or insolvency laws. This Agreement may also be terminated by either Party for any reason. Notice shall be given at least one business day before the next scheduled session. Upon termination, all fees and reimbursements shall be paid and provided to the Coach as they have accrued up to the date of termination.

Article 17 – INTELLECTUAL PROPERTY:

Coach and Client agree that all inventions, trade secrets, confidential and/or proprietary information, and work-product conceived, created or developed by each of the Parties, respectively, will be the sole and exclusive property of the Party to whom the information originally belonged. There shall be no transfer of intellectual property through this Agreement. All copyrights, patents, trademarks, or other intellectual property shall stay with the original Party owner.

Article 18 – PORTFOLIO USE:

As described above, Coach shall be permitted to use all produced items of work in Coach’s professional portfolio, if applicable, but may not use Client’s name, likeness, or other identifying details without express written permission from the Client.

Article 19 – LIMITATION OF LIABILITY:

Coach’s liability in contract, tort or otherwise arising through or in connection with this Agreement or through or in connection with the completion of obligations under this Agreement shall be limited to Fees paid by the Client to the Coach. To the extent it is lawful, neither Party shall be liable to the other Party in contract, tort, negligence, breach of statutory duty or otherwise for any loss, damage, costs or expenses of any nature whatsoever incurred or suffered by that other Party of an indirect or consequential nature including without limitation any economic loss, data loss, loss of goodwill, or other loss of turnover, profits, or business.

Article 20 – INDEMNIFICATION:

Coach and Client shall each defend, indemnify, and hold the other harmless (including all affiliates, officers, directors, employees, agents, successors, and assigns) from and against all losses, damages, liabilities, deficiencies, actions, judgments, interest, awards, penalties, fines, costs, or expenses of whatever kind (including reasonable attorneys’ fees) arising out of or resulting from bodily injury, death of any person, or damage, real or intangible, to personal property resulting from the other’s acts or omissions or the breach of any representation, warranty, or obligation under this Agreement.

Article 21 – SURVIVAL:

Any provision of this Agreement which by its terms imposes continuing obligations on either of the Parties shall survive termination of this Agreement.

Article 22 – DISPUTE RESOLUTION:

In case of a dispute between the Parties relating to or arising out of this Agreement, the Parties shall first attempt to resolve the dispute personally and in good faith. If these personal resolution attempts fail, the Parties shall then submit the dispute to binding arbitration. The arbitration shall be conducted in the county and state noted in the Governing Law provision of this Agreement. The arbitration shall be conducted by a single arbitrator, and such arbitrator shall have no authority to add Parties, vary the provisions of this Agreement, award punitive damages, or certify a class.

The arbitrator shall be bound by applicable and governing Federal law as well as the law of Alabama. Each Party shall pay their own costs and fees. Claims necessitating arbitration under this section include, but are not limited to: contract claims, tort claims, claims based on Federal and state law, and claims based on local laws, ordinances, statutes or regulations. Intellectual property claims by the Coach will not be subject to arbitration and may, as an exception to this sub-part, be litigated. The Parties, in agreement with this sub-part of this Agreement, waive any rights they may have to a jury trial in regard to arbitral claims.

Article 23 – GOVERNING LAW:

This Agreement shall be governed by and construed in accordance with the internal laws of the State in which the Client resides. without giving effect to any choice or conflict of law provision or rule. Each party irrevocably submits to the exclusive jurisdiction and venue of the federal and state courts located in the Client’s residence county in any legal suit, action, or proceeding arising out of or based upon this Agreement or the Services provided hereunder:​ Client first name​ Client last name​.

Article 24 – BENEFIT:

This Agreement shall be binding upon and shall inure to the benefit of each of the parties hereto, and to their respective heirs, representatives, successors, and assigns.

Article 25 – NO WAIVER:

No action or inaction of either Party shall constitute waiver of any of the terms of this Agreement. Waiver may only be executed explicitly in writing.

Article 26 – COUNTERPARTS:

This Agreement may be executed in counterparts, all of which shall constitute a single agreement. The Agreement shall be effective as of the date set forth above.

Article 27 – NOTICES:

All notices, requests, consents, claims, demands, waivers and other communications hereunder (each, a “Notice”) shall be in writing and addressed to the Parties at the addresses set forth on the first page of this Agreement. All notices shall be delivered by email or at the address which the parties may designate to each other through personal delivery, nationally recognized overnight courier (with all fees prepaid), or certified or registered mail (in each case, return receipt requested, postage prepaid). Except as otherwise provided in this Agreement, a Notice is effective only if (a) the receiving party has received the Notice and (b) the party giving the Notice has complied with the requirements of this Section.

Article 28 – FORCE MAJEURE:

Coach is not liable for any failure to perform due to causes beyond its reasonable control including, but not limited to, acts of God, acts of civil authorities, acts of military authorities, riots, embargoes, acts of nature and natural disasters, and other acts which may be due to unforeseen circumstances.

Article 29 – HEADINGS:

Headings to this Agreement are for convenience only. Headings shall in no way affect the provisions themselves and shall not be construed in any way that would limit or otherwise affect the terms of this Agreement.

Article 30 – ENTIRE AGREEMENT; MODIFICATION:

The agreement embodies the entire agreement between the Client and Coach relating to the subject matter hereof. This Agreement may be changed, modified, or discharged only if agreed to in writing by both parties.

IN WITNESS WHEREOF, the Parties execute this Agreement as follows: upon signature of the original document in Therapy Portal.