Health Coaching
Intake and Consent

Please submit prior to our first appointment

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  1.  Nature of the health coaching relationship

The client is hiring the coach for a coaching relationship and not for any other type of professional work.  The coach will partner with the client with the understanding that the client is responsible for creating his or her own results.  Coach and client will work collaboratively, and the coach will provide support to the client in identifying and achieving goals.  A coaching relationship is not psychotherapy.  Our work together is goal oriented and action focused.  As a social worker, I am able to and may elect to utilize some counselling techniques in order to support your goal pursuits, however we are not engaging in therapy.  Some coaching clients may benefit from psychotherapy as part of their health journey.  Should that be the case, I am happy to refer to other practitioners who can offer that type of support alongside our coaching work or, for some clients offer that support instead of or before the coaching work continues. 

Please read through this consent form.  If you have any questions, please reach out by calling 403-923-3636 or emailing journeyhealthstudio@gmail.com. Once you have had all of your questions answered, please sign, date, and submit the form. 

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. 

Your Signature

Coach's Signature

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