Intake Form

COACH & CLIENT AGREEMENT

This agreement, between Andrea Ptacek of Be New LLC hereafter referred to as the coach, and above named person hereafter referred to as the client, will begin upon submission of this form.

INVESTMENT

The investment for 8 1-on-1 sessions is $1195. These fees shall be paid in advance of the first session.

If the client needs to cancel a session, they may reschedule within 24 hours or choose to forfeit that session.

SERVICES

The services to be provided by the coach to the client are face-to-face zoom or telephone sessions, as agreed jointly with the client. Coaching may address specific personal struggles, business issues, or general conditions in the client's life or profession. Other coaching services include value clarification, brainstorming, identifying plans of action, examining modes of operation in life, asking clarifying questions, and making empowering requests or suggestions for action. Additionally, the client may be asked to reflect on difficult topics or situations which may result in an expression of emotions.

Throughout the working relationship, the coach will engage in direct and personal conversations. The client understands that successful results requires a co-active collaborative approach between client and coach. The coach will be a facilitator of change, but it is the client's responsibility to enact or bring about the change.

If the client believes the coaching is not working as desired, the client will communicate this with the coach as soon as possible and the coaching strategy will be restructured to address the client’s desired outcome of coaching.

PRIOR HISTORY

The client also agrees to disclose details of the past or present psychological or psychiatric treatment. Coaching and counselling are not the same. Likewise, therapy and other modes of professional or medical psychological examination shall not be considered equivalent to coaching.

The coach not a registered psychologist or psychiatrist, nor a licensed therapist. In entering into the coaching relationship, the client agrees that if any mental health difficulties arise during the course of the coaching relationship, you will notify your coach immediately so that she can provide an appropriate referral.

CONFIDENTIALITY

All information about the coach/client relationship will remain strictly confidential except in very rare circumstances where decreed by law; ie. where the court might issue a subpoena for the file or information.

If the client wishes for the coach to speak to someone outside of the 1-on-1 environment, the client must need provide written permission (original letter, fax or email) to do so. Exceptions to confidentiality of course relate to circumstances such as intent to seriously harm someone, child abuse, thoughts of suicide etc. Otherwise, all remaining information is kept confidential.

It is also important to note that in some situations, it is important to be aware of the use of technology in that for some clients, there is a risk in using certain media such as the internet, mobile phones and cordless phones. If you use these to communicate with me, then I will assume that it is appropriate to continue to do so in my interactions with you.

TERMINATION

If the client is present for every session and completes all Life Practice assignments, but does not feel like they have made progress, the coach will refund 100% of the client investment.

Clicking above indicates full understanding of the agreement with the information outlined herein.

GENERAL LIABILITY RELEASE

Be New, LLC is a service that provides personal coaching to specific individuals and/or groups. The client submitting this form is aware that coaching is in no way to be construed or substituted as psychological counseling or any other type of therapy or medical advice. The coach will at all times exercise their best professional efforts, skills, and care of ensuring the client is coached to meet their goals. The client understands and acknowledges the coach will not be liable legally or otherwise, for the actions the client may or may not undertake as a result of the sessions. No assumption of responsibility is made, or given, and the client requesting such advice agrees not to hold the coach responsible or liable in any form or fashion, for such actions taken of their own accord. The method and process by which this advice and direction are given in no manner whatsoever, written or verbal, constitutes an agreement or liability on the part of the coach and is acknowledged to be different in many ways than clinical and medical counseling. The client agrees that using any of these services are entirely "at your own risk." Services are provided "as is", without warranty of any kind, either expressed or implied, including without limitation any warranty for information services, coaching, uninterrupted access, or products and services provided through or in connection with the service. This service is requested at the client's own choice and with inherent singular responsibility. Any actions or lack of actions, taken by the client of such advice is done so solely by choice and responsibility of the client and is neither the responsibility nor liability of the coach. The client takes full responsibility in the decisions they make after being coached as well as the consequences. The client enters into coaching with full understanding that they are responsible for creating their own results. Periodically the coach may provide links to other websites or written print material which may be of value, interest and convenience to you. This does not constitute endorsement of material or any associated organization product of service. It is the responsibility of the user to make their own informed decision about the accuracy of the information at those sites and print material including their privacy policies. In no event shall the coach be liable for any incident or consequential damages resulting from use of the material.