Worksheet

CHI Coaching Disclaimer

Coaching by Creative Healing Integration, Inc.


MEMO OF UNDERSTANDING


The service that I wish to offer to you is life coaching. Coaching sessions may be in-person, by telephone, by email, or by videoconference.  As a life coach, I will work with you to assist you to develop skills to establish and maintain better personal and social relationships, to help you focus on this goal, to improve your self-confidence, to help you communicate more effectively for better relationships, to help you to stop repeating thinking and behavior patterns that limit your success in relationships, and generally to empower you and to encourage your personal fulfillment and self-actualization.  I will help you be more focused, attentive, and organized, improve your self-confidence, encourage your spiritual and personal fulfillment and self-actualization, help you communicate more effectively for better relationships at home and work, help you to stop repeating thinking and behavior patterns that limit your success and to empower yourself.


Coaching is not medical, mental health, or any other type of health service.  It is not psychotherapy or mental health counseling. No diagnosis, treatment, or advice regarding any medical or mental health condition or illness will be offered.  Coaching cannot substitute for and is not an alternative to, medical or other healthcare diagnosis and treatment when a medical or mental health condition or illness is present.  You are advised to seek diagnosis, treatment, and advice regarding medical or mental health conditions or illnesses from physicians, psychologists, and other licensed healthcare and mental health professionals. 


I hold master's degrees in Social Work and Fine Arts and am a Licensed Clinical Social Worker and a Licensed Art Therapist in the States of  NY, NJ, FL, and CA and in my professional practice, I specialize in Complex Trauma.  However, the services I wish to offer to you are not medical, psychiatric, psychological, psychotherapy, or any type of healthcare or mental healthcare service. That I have professional licenses does not mean that my coaching services are necessarily superior to the services of an unlicensed life coach.  Health insurance companies do not reimburse for life coaching services.  If you wish for healthcare or mental health assessment, counseling, or psychotherapy, then I can provide you with referrals at your request. 


Please sign below indicating that you understand the nature of the coaching services that I wish to offer you and that you have had the opportunity to ask any questions you might have about them.




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Name (Print) Signature             Date 

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