SCJMental Health Coaching

Client Consent Form

Please read each section carefully, check your agreement, and sign digitally below. All information is kept strictly confidential.

Client Information

Full Name *

Email Address *

Phone Number *

Date of Birth *

Emergency Contact Name *

Emergency Contact Phone *

Nature of Coaching Services

I understand that mental health coaching provided by SCJ Mental Health Coaching is not therapy, counseling, or mental health treatment. Coaching is a supportive, educational, and motivational mental health service designed to help individuals achieve personal wellness goals.

I have read and agree to the above.

Confidentiality

I understand that all information shared during coaching sessions will be kept strictly confidential, except where disclosure is required by law (e.g., risk of harm to self or others).

I have read and agree to the above.

Voluntary Participation

I understand that my participation in coaching is entirely voluntary and that I may discontinue services at any time without penalty.

I have read and agree to the above.

Fees & Payment

I agree to pay all fees associated with coaching services as outlined during intake. I understand that missed appointments without 24-hour notice may be subject to a cancellation fee.

I have read and agree to the above.

Communication Consent

I consent to receive communications from SCJ Mental Health Coaching via email or phone regarding appointments, resources, and wellness information.

I have read and agree to the above.

Digital Signature

Type your full name as your digital signature *

By typing your name above, you agree this constitutes your legal digital signature.

Date *