Elemental Collaborative
Individual Coaching Intake Form
Please complete the following information to get started with Elemental Collaborative.

Agreements & Consent

Please read each section carefully and check the box to indicate your agreement.

Service Agreement

This agreement establishes the professional relationship between the client and Elemental Collaborative LLC ("Coach"). Coaching is a collaborative, forward-focused relationship designed to help clients achieve personal, professional, or recovery-related goals.

  • Sessions are scheduled in advance and held at agreed-upon times.
  • Session fees are due at the time of service unless a payment plan has been arranged in writing.
  • Cancellations require 24-hour advance notice. Late cancellations or no-shows may be charged the full session fee.
  • Either party may terminate this agreement with written notice. Prepaid fees for unused sessions will be refunded on a prorated basis.
  • Coaching is not a substitute for therapy, medical treatment, or legal advice.

Consent for Virtual Services

Elemental Collaborative may provide coaching services via video conferencing, phone, or other secure digital platforms. By consenting to virtual services, you acknowledge:

  • Virtual sessions carry inherent technology risks including connection interruptions, which are not the responsibility of the Coach.
  • You are responsible for ensuring you are in a private, secure location during virtual sessions.
  • Sessions will not be recorded by either party without prior written consent.
  • In the event of a technical failure, the Coach will attempt to reconnect or reschedule without penalty.
  • Virtual coaching is not appropriate for crisis situations. If you are in crisis, please contact 911 or a crisis hotline immediately.

Elemental Collaborative Policies

By engaging with Elemental Collaborative, you agree to abide by the following policies:

  • Confidentiality: All client information is kept strictly confidential, except as required by law (e.g., imminent risk of harm, mandatory reporting obligations).
  • Communication: Between-session contact is welcome via email or phone for scheduling. Extended between-session coaching may be billed accordingly.
  • Respect: A respectful, safe environment is maintained at all times. Abusive language or behavior may result in termination of services.
  • Social Media: The Coach will not engage in therapeutic communication via social media platforms.
  • Referrals: If the Coach determines that your needs fall outside the scope of coaching, you will be referred to an appropriate professional.
  • Grievances: Any concerns about services should be directed to info@elementalcollaborative.com and will be addressed promptly.

Informed Consent for Coaching

Coaching is a distinct service from psychotherapy, counseling, or medical care. Please review the following before proceeding:

  • Nature of Coaching: Coaching focuses on present circumstances and future goals. It does not diagnose or treat mental health conditions.
  • Voluntary Participation: Your participation in coaching is entirely voluntary. You may discontinue at any time.
  • No Guarantees: While the Coach will provide full professional support, specific outcomes cannot be guaranteed. Results depend on your active engagement and effort.
  • Dual Relationships: To maintain professional integrity, social or business relationships outside of coaching are avoided.
  • Emergency Protocol: Coaching sessions are not crisis services. If you experience a mental health emergency, you agree to contact 911 or the 988 Suicide & Crisis Lifeline.
  • Right to Refuse: You have the right to refuse any coaching technique or activity at any time without penalty.