Consent to participate in parent coaching

Do you understand and agree that by starting parent coaching with Cheyenne Lofthouse-Wolf, LCSW, you will not be receiving therapy services, and that receiving parent coaching services does not establish a therapeutic relationship?

I understand that parent coaching is a supportive, educational and goal-oriented service designed to help me improve my parenting skills and strategies.

I understand that the parent coach is not acting as a licensed therapist in this capacity, even if they hold clinical credentials. If concerns arise that are outside the scope of coaching, I may be referred to a licensed mental health provider.

I understand that parent coaching services are not appropriate for emergency situations or crises. If I or my child are experiencing a mental health crisis, I agree to contact my local crisis hotline or 911.

I agree that all information shared during coaching sessions will be kept confidential to the best of the coach's ability. My personal information will not be shared with third parties without my consent.

I understand that there are exceptions to confidentiality. The coach may disclose information if there is reason to believe that I or my child may be at risk of harm to self, others, or in instances of abuse or neglect.

I understand that parent coaching is not a healthcare service and may not be subject to the same privacy laws and protections as therapy. The coach will take reasonable steps to protect my privacy.

I understand that coaching is a collaborative process and that my progress depends on my willingness to actively participate, implement strategies, and communicate openly. I acknowledge that results are not guaranteed.

I agree to pay all fees associated with parent coaching services as outlined. Payment is due prior to each coaching session. I understand that failure to submit payment may result in cancellation or reschedule and a 50% service fee.

I agree to provide at least 48 hours' notice if I need to cancel or reschedule a session. I understand that late cancellations or missed sessions are subject to a 50% service fee or may count as a completed session.

I understand that coaching services are non-refundable. Any exceptions are at the sole discretion of the coach.

I understand that the coach will work within the scope of parent coaching and will not provide services outside of that scope. If my needs exceed what coaching can provide, I may be referred to appropriate professionals.

I understand that I am solely responsible for the care, supervision and well-being of my child(ren). I understand that all decisions and actions taken based on coaching guidance are my responsibility.

I understand that communication between sessions may be limited to email, text messaging and phone calls, and responses may take 24–48 hours. Coaching does not include on-demand or parental emergency support.

I understand that my experiences may be used in an anonymous and confidential manner for educational, training, or content creation purposes. No identifying information will ever be shared.