Shane Young Wellness Coaching agreement –
Welcome to my wellness coaching practice. This document contains important information and outlines my policies and our agreements for working together. Please read the document carefully and contact me if you have any questions or concerns prior to signing the document.
The coaching relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with me. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.
Matters you disclose are confidential, except as required by law in cases of child or elder abuse, or where you indicate potential harm to yourself or another.
55 minute sessions are $195
85 minute sessions are $292
The wellness coach must be paid immediately after of each wellness session. Payments can be made in 2 different forms: 1) cash 2) Venmo.
Phone, email, texting
If you need to contact me between sessions, please text me or leave a voice message on my cell phone at (415) 757-8206 and your message will be returned as soon as possible. If your call is urgent and you are in need of emergency services, please dial 911.
I will not charge for a call less than ten minutes. If a longer conversation is needed, regular, pro-rated rates apply. In such cases, I will let you know as we proceed. Please feel free to email any time to update me on issues we’re exploring.
Regarding Electronic Communication: It is important to be aware that computers and unencrypted email and texts can be relatively easily accessed by unauthorized people which can compromise the privacy and confidentiality of such communication. If you communicate confidential or private information via unencrypted email, texts, or phone messages, I will assume you have made an informed decision, and I will view it as your agreement to take the risk that such communication may be intercepted, and will honor your desire to communicate on such matters.
A minimum of 24 hours notice is required for rescheduling or cancelling an appointment. The full fee will be charged for sessions cancelled within a 24-hour window. A minimum of 1 week notice is required for rescheduling or cancelling a retreat appointment. The full fee will be charged for sessions cancelled within a 1-week window.
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
1.If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm.
2.If a client threatens grave bodily harm or death to another person.
3.If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
4.Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
5.Suspected neglect of the parties named in items #3 and # 4.
6.If a court of law issues a legitimate subpoena for information stated on the subpoena.
7.If a client is in therapy or being treated by order of a court of law, or if the information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally I may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.
Confidentiality in an Emergency
If there is an emergency during therapy where I become concerned about your personal safety, the possibility of you injuring someone else, or about your receiving proper mental health care, I will do whatever I can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper care. For this purpose, I may also contact the person whose name you have provided as an “emergency contact”.
Shane Young, Transformational Coach