Client Information +
Mutual Service Agreement

Welcome +
Service Expectations

What to Expect

  • Sessions are structured with respect, care,
    and a focus on what feels supportive for you.

  • You are in control—nothing is forced or prescribed. Our sessions are collaborative.

  • If ever something is beyond the scope of these methods, or outside your comfort zone,
    we can pause, adjust, or refer out as needed.

  • All information shared is confidential, with exceptions only in cases of immediate risk to
    self or others, or a request to contact
    designated support.

Sliding Scale

    • You select the tier that most closely matches your current household income and circumstances.

    • No proof of income is required—we trust your self-assessment.

    • Rates are meant to be a guideline, not a rule. If your situation doesn’t fit neatly into a tier, we’ll work together to find a fair rate.

  • Based on Annual Household Income

    A. Under $30,000 $40-$60 per hour,
    Students, younger adults starting out, marginalized communities, those with limited work opportunities

    B. $30,000–$50,000 $80-$100 per hour,
    Early-career professionals, part-time workers, single-income households

    C. $50,000–$80,000, $120 per hour,
    Mid-career professionals, dual-income households without dependents

    Over $80,000, $150 per hour
    Established professionals, dual-income households with financial stability

Practitioner I Am

Here you are honored as an individual worthy of dignity, respect, and the endless opportunity to grow through anything you choose. You are met where you are by a teacher, a graduate student, and a certified wellness practitioner, not a licensed clinical mental health provider. This work does not involve diagnosing or treating mental illness. Instead, it focuses on integrating boundless consciousness and the human potential of each client as a complementary service.

  • Holistic Wellness, Meditation Practices Certification:

    This training incorporates the whole person—body, mind, and spirit. I use natural, mindful, and integrative strategies to support balance, well-being, and self-awareness in everyday life.

  • Trauma-Informed Care Trainings:

    This approach ensures safety, trust, and empowerment are at the center of our work. It acknowledges the presence of trauma and prioritizes care that avoids re-triggering while encouraging healing and resilience. [DCF Trauma-Informed Care for Child Care Professionals, Florida Safe Schools]

  • Certificate, Cognitive Behavioral Therapy (CBT):

    CBT offers practical tools to help reframe unhelpful thought patterns. It helps people become more aware of how their thinking affects their emotions and behaviors, and gives them strategies to shift those patterns in ways that support growth.

  • Master Practitioner, Neuro-Linguistic Programming (NLP):

    NLP is a powerful method for identifying how we mentally represent our experiences. Through subtle language shifts and perspective changes, NLP helps people build new ways of thinking, improve communication, and unlock personal potential.text goes here

Client Information:

Informed Consent:

Nature of Services

Services provided include non-clinical support, mental health crisis intervention, emotional regulation strategies, and wellness coaching. These services are grounded in trauma-informed care and draw from cognitive-behavioral strategies, NLP, and holistic practices. Sessions may include conversation, breathwork, mindfulness techniques, and resource referrals. The duration of services may vary based on individual needs but will generally be short-term, goal-oriented, and solution-focused.

Voluntary Participation

Participation in services is entirely voluntary. Clients may decline to participate or withdraw consent for services at any time without penalty. The client has the right to ask questions, express concerns, or request changes to the format or frequency of sessions.

Risks and Benefits

While services aim to support emotional well-being, some clients may experience discomfort when discussing difficult topics. These effects are typically short-term and part of the healing process. Benefits may include reduced stress, increased emotional awareness, enhanced coping skills, and improved self-regulation. However, there is no guarantee of specific outcomes.

Confidentiality

All personal information shared during services will be treated as confidential and stored securely. Information will not be released to third parties without written consent, except in cases where there is a legal or ethical obligation to report, including suspected abuse, harm to self or others, or a court order. Documentation may be reviewed by authorized support personnel for quality assurance or training purposes, in compliance with privacy standards. For more information about emergency circumstances, please read this crisis intervention outline.

Payment Authorization & Recurring Billing Agreement

To ensure continuity of care and ease of access to services, we require a valid payment method to be kept on file for all clients engaging in Mindset Coaching and Crisis Intervention services.

By entering your card information, you acknowledge and agree to the following terms:

1. Secure Storage & Authorization

Your payment information is securely stored via encrypted third-party payment processing and will only be used for authorized charges related to your agreed services. You may update or revoke authorization at any time by written request, provided there is no outstanding balance.

2. Recurring Payments for Mindset Sessions

For clients engaging in regular mindset coaching, your card will be charged automatically based on your selected plan or session frequency. You will be notified of your billing schedule at the time of booking, and may cancel or reschedule sessions in accordance with our cancellation policy.

3. Crisis Intervention Payment Terms

Clients receiving Crisis Intervention services who enter inpatient or emergency hospitalization will be placed on a zero-interest recurring payment plan upon discharge. This plan will include:

  • A minimum weekly payment of 1% of the total outstanding balance

  • Automatic charges to the card on file until the balance is paid in full

  • A regular payment schedule confirmed in writing before the first charge is applied

  • Option to pay in full or increase payments at any time without penalty

These terms are designed to offer flexibility and financial ease while ensuring sustainability of services and availability to others in need.

Client Responsibilities

Clients are expected to:
• Be honest and open to the best of their ability.
• Attend scheduled sessions or notify in advance if rescheduling is necessary.
• Communicate clearly about goals, needs, or concerns.
• Engage actively and respectfully in the process.

Provider Responsibilities

The provider agrees to:
• Create a safe, respectful, and non-judgmental environment.
• Maintain professional boundaries and ethical standards.
• Tailor support to the client's expressed needs and preferences.
• Provide referrals when care is needed beyond the provider's scope of practice.
• Document services appropriately and protect client privacy.

Consent Statement:

Voluntary Contacts: