Emotion Regulation Agreement

EMOTION REGULATION COACHING AGREEMENT

General Information

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.

Coaching Agreement This agreement is a partnership between Kate Engel, your coach, and the client.

Coach’s role:

1. As your coach, we will teach you coping tools and strategies to help regulate your emotions specific to ADHD. It is your decision to carry out these coaching requests.

2. This coaching process will help in practicing the skills to deal with emotion regulation. We will do my best to help you reach the goals you set for yourself, but the ultimate responsibility lies with you taking responsibility for the success you want.

We can’t guarantee results in life as these are dependent upon us creating the changes we need to achieve them.

4. Developing trust is of the utmost importance and trust can’t be developed without confidentiality. Anything you share with us will be kept strictly confidential except if we have good reason to believe you have the intention to harm or have harmed somebody else. Confidentiality between group members is expected. By signing this Group Coaching Agreement, you are agreeing not to disclose to anyone outside the group any information that would identify any other group member. This includes, but is not limited to: names, birth dates, physical descriptions, and the content of interactions with group members.

5. By signing this form, you also agree to share your email address with other group members for the purpose of sharing resources. Your email address will not be used outside of group sessions functions.

Client’s role:

1. Make your coaching a priority in your life. Make sure you give yourself time each week to complete all coaching requests.

2. Acknowledge that you are committed to moving forward to a more positive life.

3. It can sometimes be frustrating to learn how to manage your ADHD. Be open to play, trying something new, and learn which ADHD tools work best for you. Be willing to look at your patterns and beliefs and change what isn’t working.

If we see each other accidentally outside of the office, we will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge us first, we will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the office.

Payment

1. Full payment is required before the start of each session. We accept credit card. With your permission, we can store your credit card information in a secure program to make the payment process quick and easy. We reserve the right to charge your card for a late session fee or suspend or terminate coaching services, without liability, if you have not paid in full within a week of the receipt of the invoice for services.

2. In addition to weekly appointments, it is our practice to charge the agreed-upon fee on a pro-rated basis for other professional services such as report writing, letter writing, telephone conversations longer than fifteen minutes, attendance at meetings, or the time required to perform any other service you may request of me.

3. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, we have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. [If such legal action is necessary, its costs will be included in the claim.] In most collection situations, the only information we will release regarding a patient’s treatment is his/her name, the dates, times, and nature of services provided, and the amount due.

4. You are responsible for coming to group session on time and at the time we have scheduled. Sessions last for one hour. If you are late, we will end on time and not run over into the next person’s session. If you miss a session without canceling, or cancel with less than 24 hours notice within business hours (Monday-Friday), you will be charged for that session. Failure to pay the late fee means you cannot join group session until it is paid.

5. Due to the nature of the group coaching sessions, no refunds, in whole or in part, will be provided for the discounted package rate if you miss a group coaching session unless there is an emergency or an act of God.

6. Should you want to withdraw from the group, please notify me a week in advance.

7. If you are absent three times, you will be terminated from the group coaching program and your package payment is non-refundable.

6. The emotion regulation group requires a level of engagement and commitment. We request that you have your camera on and are engaged and present in the group in order to benefit from learning the skills.

Coaching Work Hours and Email

Coach’s work hours are Monday-Friday 9am-5pm. The coach checks emails twice a day at 12 noon and 4pm. All emails will be answered on workdays within 24-48 hours.

Dispute resolution: If a dispute arises between coach and client which cannot be resolved, we agree to enlist the services of an independent arbitrator. The independent arbitrator will resolve the dispute with fees to be split between the parties.

Disclaimer: We will work with you to help you move forward with issues relating to managing ADHD issues and how they affect your life. We are qualified as ADHD coaches in these matters and agree to provide coaching services to you.