Fitness Waiver and
PAR Q
_edited.png

Please submit prior to your first class

arrow&v

Physical Readiness 

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

2.  About health coaching

Health coaching is a process that facilitates healthy, sustainable behaviour change by challenging a client to develop their inner wisdom, identify their values, and transform their goals into action.  We will co-create goals, identify strengths, build on successes, explore new ideas and strategies, and monitor progress.  Health coaching requires a significant amount of work on the clients part which may include logging food (for example consumption and choices), client activity including exercise, exploring new food choices, examining current habits, and looking at past successes.  

As your coach, I agree to do the following:

  • Conduct scheduled coaching sessions online via Zoom

  • For every one full session (typically one hour), I include two check ins (if needed) via email, phone, or text. I will strive to respond to emails within one business day (except on holidays)

  • Work with you through inquiry and dialogue to clarify your goals and design  your action plan.  I will           also provide accountability and ongoing support for your goal-directed activities

  •  Give you feedback about issues that may impede your progress

  •  Inform you about matters that I believe are affecting our working relationship

  • Strive to notify you at least 48 hours in advance if I need to cancel a meeting, except in case of dire emergency

  • Follow the Alberta College of Social Workers Code of Ethics and Best Practices.  Any concerns or complaints about my conduct can be made to the Alberta College of Social Workers (www.acsw.ab.ca) All of our sessions will be kept confidential with the only exception being if I have reason to believe that you are in danger of harming yourself or others, then I have a non-negotiable legal responsibility to report these concerns to the appropriate authorities who may take whatever actions are needed to ensure no one comes to any harm

As your client I agree to do the following:

  • Show up on time for scheduled meetings.

  • Commit myself to the coaching process and to the goals we agree upon. 

  • Be willing to talk with you about any issues that pertain to my progress or how we are working together.  I will also let you know if anything you do or say does not feel right to me.  

  • Pay for my sessions as per the terms agreed upon

  • Give two business days notice of any changes or cancellations to appointments we have scheduled  

  • Pay for any sessions that I cancel less than 48 hours in advance, except in the case of extreme circumstances. Please note that no future sessions will be booked if there is an outstanding balance on the account due to missed appointments

3. Fees and Payment

Sessions can be paid for by debit, credit card, or E-Transfer. A receipt will be issued immediately to the client.  The coach does not provide any direct billing to insurance companies or benefits plans.  Clients are solely responsible for submitting receipts for reimbursement through extended health benefits plans, if applicable.  These services are also able to be written off as medical expenses for tax purposes. Payment plans are available.  Please select your chosen package and how you would like to pay below.

Please indicate your chosen plan:
Please select payment frequency:

Place of appointments: 

Appointments will be held online through Zoom.  Clients will be required to have access to a laptop, tablet, or phone and an internet connection.  The Zoom application is free of charge for clients to download and run for the purposes of our appointments.  Journey Health Studio assumes no liability for any technological issues occurring as a result of downloading, installing, or running Zoom.  

Duration of this agreement: 

This agreement is in effect one year from date of signing, unless otherwise indicated or revoked in writing by either party. 

Screen Shot 2020-01-06 at 10.33.03 AM.pn

Coach's Signature

Click here to download an unsigned copy of the consent form