Client Consent Waiver Form
Life Coaching Services: Life coaching practices and services are varying according to specific problems of clients. Since this is not an accredited profession and there exists no governing body or regulations requiring an official license or certification.
There are many techniques that are applied by life coaches to be helpful for clients. Spiritual life coaching duration can be varied with respect to the client’s obstacles. In this case, the coach has expertise, knowledge or experience in a particular area and coaches their clients to find the answers at their own pace. The patient accepts that coaching practices may include mentoring and guiding clients through particular area in their life. Sessions may be practiced via video sessions and audio connection.
Risks: Spiritual sessions have both benefits and risks because the session mainly involves various parts of clients lives. Clients may experience some undesirable feelings before, during and after each session. On the other hand, the session will provide solutions to problems and uncomfortable situations. Hence, the client accepts that he/she can benefit from spiritual life coaching sessions; however, the result is not certain and cannot be guaranteed.

Confidentiality: Personal information of clients will be kept private and that is an obligation by the governmental laws. The coach is not responsible for any pain or discomfort, during and after spiritual, life coaching sessions.
Rights: The patient can withdraw or withhold the consent at any time and this will not affect the future practices and treatment.
The coach may withdraw you from this study at any time he/she feels it is in your best interest. The session will continue until the coach and/or you decide to stop. This may include discontinuation without your consent. The coach in charge of this protocol may remove you from the session without your consent based upon his/her medical judgment regarding your safety or due to your willful failure to follow through.
Do you have any life-threatening, concerning medical conditions? (including self-harm or suicidal behavior)
Yes No
Check To Agree To The Following Statements:
I client full name* verify that all information is correct and current to the best of my knowledge. I understand that any information provided is for safety purposes and will be kept strictly confidential, unless I provide written consent. I hereby give my consent to receive sessions and I acknowledge and agree that I am doing so at my own risk. My health and safety with respect to such services are my sole responsibility. My decision to receive services is voluntary, and I know of, understand and assume any and all the risks associated therewith. In exchange for receiving services for myself and on behalf of my heirs, executors, administrators and personal representatives, hereby waive, release, discharge and hold Estefania Acosta (life coach) harmless from any and all liability for any and all injuries, including damages or claims relating to or resulting from my receipt of the services, now or in the future, foreseen or unforeseen.
By signing below, you acknowledge that you have read this Consent Form, you have been given the opportunity to ask questions and you understand what this coaching session involves. You freely consent to participate, with the understanding that you may withdraw your consent by leaving the session. You also acknowledge that you have received an appropriately executed copy of this informed consent.
Signature*
Clear
Client Name
First Name Last Name
Date
Month Day Year
You can print the form with "Print Form" before the submission in order to get a hard copy for your records.
Should be Empty:

Client Consent Waiver Form