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Tele-coaching Agreement

This document sets forth the terms and conditions of my services to you.  It also provides an acknowledgement and acceptance by you of those terms. 

You should read About Tele-coaching and this form carefully and raise any questions or concerns that you have before you agree to these terms.
By signing the tele-coaching agreement, I agree to the following statements: 
-I understand that Dr. Scharp is providing tele-coaching and not clinical therapy.

-I understand that I might benefit from tele-coaching, but results cannot be guaranteed or assured.​

- I understand that fees for coaching sessions must be paid upfront unless an alternative arrangement is agreed to in writing. 

- I understand that cancellations made with less than 24 hours notice will be charged at the full rate unless I am able to fill your scheduled time.

- I understand that Dr. Scharp will not submit bills to your health insurance provider.

- I understand it is impossible to guarantee the protection of information that is transmitted electronically. By entering into this agreement, you are consenting to the use of electronic communication between us via unencrypted mediums.

- I understand that I am committing myself to maintain the confidentiality of all information communicated to you by other coaching clients and by me.  

- I understand that information disclosed to me during the course of my coaching, although generally confidential, might be subject to mandatory confidentiality exceptions, including reporting child, elder, and dependent adult abuse; or reporting of expressed threats of violence toward an identifiable victim.

Tele-coaching Agreement

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