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New Client Form

Name *
Name
Phone *
Phone
Address *
Address
Participant Informed Consent and Waiver of Liability *
I acknowledge that I am voluntarily participating in the Applied Mindfulness Meditation Coaching. I acknowledge and understand that I am responsible for all aspects of my health and well-being. I further recognize and understand that the instructions and advice presented to me during the coaching are in no way intended as substitutes for medical and/or other professional counselling. If I have any health concerns that may interfere with my participation in the coaching, I understand that I should consult my healthcare provider before beginning the meditation exercises. If I experience pain or difficulty that is cause for concern during or after practising the meditation exercises, I understand that I should stop immediately and consult my healthcare provider before continuing on with the meditation exercises. I recognize, understand, and assume all risks associated with my voluntary participation in the coaching, including, but not limited to, those risks that may result in personal injury and death. In giving my informed consent to participate in the coaching, I hereby release Life Coaching & Meditation from any and all claims, now or in the future, that I may have as a result of my voluntary participation in the coaching. I agree that I have read and fully understand the above statements.
Cancellation Policy and Agreements *
1. LCM has a strict 24 hours notice policy for cancellations or changes of scheduled appointments. Clients will be charged the full rate for cancelling or missing appointments with less than 24 hours notice. 2. Be on time for all sessions. If you are late for your appointment, it will still conclude at the scheduled time. 3. Please turn your cellphone ringer to silent during all appointments. 4. All information that you share will be held as confidential. 5. It is your responsibility to let me know if there are any specific goals or topics you would like to discuss or explore. 6. It is your responsibility to let me know if you are currently in therapy or under the care of a mental health professional. 7. I understand that coaching does not involve the diagnosis or treatment of mental disorders as defined by the Canadian Psychiatric Association. I understand that coaching is not a substitute for counselling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment and I will not use it in place of any form of diagnosis, treatment or therapy.