Online/Telephone Life Coaching Agreement The following document is to inform you about Life Coaching services, and to ask

for your permission to enter into a coaching partnership with you. This document is not a binding contract that demands you to continue services for any length of time. If the coaching recipient is under the age of 18 or the adult counseling recipient has relinquished guardianship due to any reason, then the legal guardian along with the primary recipient must sign below. Feel free to contact me about any questions you may have about this form (210) 245-2579 or E-mail: help@quintolpc.com Life Coaching is a professional partnership between Client and coach, defined by responsibilities and rights from each party. The Client is responsible for participating in, and being present for scheduled sessions. The Life Coach must follow ethical guidelines and provide professional life coaching services with the best interest of the client in mind. Please note, coaching is not meant to take the place of in depth therapeutic counseling services. The scope of coaching is limited and will not treat deeper emotional concerns meant for professional counseling. If therapeutic counseling services are needed we will discontinue coaching services and you will be given the choice of receiving professional therapeutic counseling services from me as I am Licensed in the state of Texas as a professional counselor or I can refer you to another counselor.

Consumers Rights, Risks and Responsibilities I understand that Quinto Sanchez will be providing life coaching services via telecommunication devices such as: Skype, chat, electronic mail, standard telephone connection, and/or other online software and technology. I agree as the recipient of these coaching services to have the technological means and awareness required for online or telephone services. I agree to fulfill my responsibility of attending class as scheduled and to complete self-enrichment activities and assignments determined by my coach and I. I understand that the nature of coaching requires dedication, focus and stepping out of my comfort zone sometimes. I am aware that I have the right to cancel these coaching services at anytime. If you have any concerns or are not satisfied with my services please let me know, that we may mutually come to an agreement to resolve the matter. I want you to have a positive life changing experience here with Foundational Healing.

Emergency numbers In the case of an emergency you are to contact 911 or the nearest emergency room. You can also call the 24 hour Crisis hotline at 1 (800) 273-8255 (TALK). For victims of sexual assault you can call 1 (800) 656-4673 (HOPE) Coaches Rights and Responsibilities I Quinto Sanchez as your professional Life Coach agree to treat you with the utmost respect, providing professional coaching services. I agree to use advanced psychological and counseling skills to meet your determined goal for your greater well being. I have a Bachelors degree in Psychology and a Masters degree in Community Counseling from the University of Texas at San Antonio and will do my very best to assist you with your presenting concerns. My goal is to empower you to find your own solutions to your greatest ambitions. It is crucial that you help me help you. You can only get as much out of coaching as you put into it. I will most likely ask you to complete assignments that I feel would assist you and it is important that you complete them. I reserve the right to discontinue services if I feel that our coaching relationship is no longer a benefit to you, or if you are not complying with your responsibilities as the recipient of these services. Duties and Limitations of Confidentiality I am required to keep what we speak of in session confidential. While it is rare and unlikely, you must understand that telecommunication is less confidential because it can be hacked by another individual, e-mails and phone calls could be intercepted, or flawed software glitches can expose information. I will do everything on my end to insure that never happens, and I trust that you would do the same on your end. I will not give information about specifics of what you have told me or even if you are receiving coaching services, to a family member or to any third party without your written consent. However, by law, I must report or notify the proper authorities or a family member based on the following reasons: 1. The intention to commit suicide 2. The intention to harm someone else 3. If summoned by a court of law

Be assured, that in the instance that I were required to give out your information I would only give what is necessary. Your trust is very important to me. MISSED Sessions AND CANCELATIONS Our sessions will be 30 minutes long either weekly or bi-weekly. The frequency of sessions will be mutually agreed upon by the client and coach. After two consecutive no shows your services will be canceled Clients are required to contact their coach 24 hours in advance to cancel or reschedule their appointment. Frequent cancelations may result in your services being canceled Clients will be charged for no shows and late cancelations

This policy will be enforced to insure that those dedicated to seeking life coaching can be served. I hope you have a wonderful and enlightening experience here with Foundational Healing Counseling Services.

Payment Policy All participants signed up to receive coaching services will be given the first session free of charge. Payments must be received using Pay Pal before the session begins. I Offer weekly and Bi-weekly life coaching sessions for the fee of $50 per session. Weekly sessions, meaning once a week and bi-weekly sessions meaning once every 2 weeks. Each session is 30 minutes long. You are also given the option to purchase a package of 4 weekly sessions at the price of $45 per session. Note that the 4 session package requires the payment of $180 pre-payed, and is non-refundable. This is a weekly package and you are expected to comply with your responsibilities. Cancelations must be made no less than 24 hours in advance. A late cancelation will result in a $10 charge which must be paid before the following appointment is scheduled. A no show is when you do not call to cancel and you do not make your scheduled appointment. If you no show you will be charged $30 All financial transactions will be made using Pay Pal. Pay Pal is a secure online third party payment service used by several online companies such as E-Bay and Amazon. Pay Pal gives you the option to pay using your bank account or through a credit card. For further information on Pay Pal services or to create an account with them please visit their website WWW.paypal.com.

I ________________________ (type or print name) have read and understand my responsibilities and the responsibilities of my coach Quinto Sanchez. I have been given the opportunity to ask any questions about this consent form. I agree to receive online coaching services from Quinto Sanchez M.A, LPC

Coaching recipients Signature _________________________ Date ____________________ Legal Guardian (if applicable) _________________________