Client Intake Form and Coaching Contract

  • I understand that coaching is not psychotherapy or counseling. The life coaching services I will receive from Christa Gallopoulos are not offered as a substitute for mental health care. Christa Gallopoulos is not acting as a psychotherapist, and does not purport to offer mental health care.
  • I understand that all comments and ideas offered by my coach, Christa Gallopoulos, are solely for the purpose of aiding me in achieving my goals. I have the ability to give my informed consent, and hereby give such consent to my coach to assist me in achieving such goals.
  • As a client, I understand and agree that I am fully responsible for my own well being. I am responsible for any and all choices and decisions I make.
  • My coach is committed to keeping all contacts, information, and records confidential. From time to time, information may be shared with other coaches for training and feedback purposes; however, the client, along with any other identifying information, will always remain anonymous.

Name:
Today's date:
Address:
Your email:
Home phone:
Cell phone:
Spouse, partner, roommate:
Birthday:
Children (name and age):
Anything I should be aware of?

           

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