CONSENT FORM FOR COACHING/MENTORING/CONSULTING/REIKI SERVICES:Please take a moment to read this entire consent form carefully before you sign it and please ask any questions you may have. This form is intended to inform you of the service or services provided by Shannon Myers, MS, CRC, CIMHP, Founder of Shannon Myers Consulting LLC and The Integrative Counselor LLC.
DESCRIPTION OF COACHING SERVICES:
Coaching is a collaborative process that aims to help you achieve your personal and professional goals. Coaching is not counseling, therapy, or medical advice. Coaching does not diagnose or treat any physical or mental health condition. Coaching may involve exploring your values, strengths, challenges, opportunities, and action plans. Coaching may also involve providing feedback, guidance, support, accountability, and resources. Coaching sessions may take place in person, by phone, online, or by video call. The duration and frequency of coaching sessions may vary depending on your needs and preferences. The fees for coaching services are $200 per 55-minute online or in-person session and packages are available for financial savings. Packages are valid for one year from their payment date. Payment is due before each session or package. Coaching services include: nervous system retraining coaching, Somatic Experiencing, Safe and Sound Protocol, Life Coaching, Executive Coaching, Psychedelic Integration Coaching, Spiritually Transformative Experiences Coaching, Integrative Mental Health Coaching, The Reboot Group Coaching, and Group Coaching through online and in-person groups. Both you the coaching client or Shannon Myers may determine at any time to discontinue coaching services.
Coaching may have both benefits and risks. Potential benefits may include but are not limited to: increased clarity, confidence, motivation, productivity, satisfaction, and well-being; improved relationships, communication, performance, and outcomes; enhanced learning and growth; positive changes in behavior and habits. Potential risks may include but are not limited to: experiencing uncomfortable emotions such as sadness, anger, frustration, anxiety; facing difficult challenges or decisions; encountering resistance or setbacks; discovering aspects of yourself that you may not like or want to change. Shannon will do her best to support you throughout the coaching process to help you cope with any difficulties that may arise. However, she cannot guarantee that coaching will be effective for you or that you will achieve your desired goals.
DESCRIPTION OF MENTORING SERVICES:
Mentoring is a reciprocal learning relationship between a mentor and a mentee. The mentor, Shannon, shares their knowledge, skills, and experience with the mentee, you, to help you progress. The goal is to develop your skills, abilities, knowledge, and/or thinking. Mentoring is usually focused on long-term career development. The primary purpose of mentoring is to drive your personal growth. Mentoring sessions may take place in person, by phone, online, or by video call. The duration and frequency of mentoring sessions may vary depending on your needs and preferences. The fees for mentoring services are $200 per 55-minute online or in-person session and packages are available for financial savings. Payment is due before each session or package. Packages are valid for one year after their payment date. Mentoring services may also provided in a group format. Both you or Shannon may determine at any time to discontinue mentoring services.
DESCRIPTION OF REIKI SERVICES:
Reiki is a natural method of energy balancing that can never harm. Reiki is intended to reduce stress and promote relaxation. Reiki is a safe method of treatment with no known side effects. Reiki does not interfere with traditional medical treatment. Reiki is not a substitute for medical care and is not massage therapy. Reiki practitioners do not diagnose conditions, do not prescribe or perform medical treatment, do not interfere with the treatment of licensed medical professionals, and are not responsible for the outcome of the Reiki session.
DESCRIPTION OF CONSULTATION, TRAINING, AND EDUCATIONAL SERVICES:
All consultation, training, and educational services will be agreed upon by all parties involved prior to the delivery of the end product. The payment will be agreed upon by all parties up front prior to consultation, training, or educational services are delivered. Consultation services may be terminated at any time and by any party involved
VOLUNTARY PARTICIPATION AND WITHDRAWAL:
Your participation coaching, mentoring, Reiki, or consultation services is voluntary and you may withdraw at any time. You may also decline any suggestions or feedback that Shannon may offer. You are solely responsible for your own decisions, actions, and results. Shannon do not guarantee any specific outcome or result from any of her services. If you are dissatisfied with the services or wish to terminate the coaching, mentoring, consultation, or Reiki practitioner relationship, please let Shannon know as soon as possible. Shannon will respect your decision and provide any assistance or referrals as needed.
CONFIDENTIALITY:
The information you share in coaching, mentoring, and Reiki sessions will be kept confidential, except in rare circumstances where disclosure is required by law or necessary to protect your safety or the safety of others. These circumstances include but are not limited to: intent to harm yourself or someone else; child abuse or neglect; elder abuse or neglect; court order or subpoena. If you wish for Shannon to share information with someone else (e.g., a family member, a friend, a professional), you must provide written permission and consent by mail, email, or a signed release form. Please note that communication by email or other electronic means may not be completely secure and confidential. By using these methods of communication, you agree to assume the risk of unauthorized access or disclosure.
If you wish for Shannon as your coach, mentor, or Reiki practitioner to speak to someone outside our secure interactions, Shannon must receive written permission and consent by mail, email, or a signed release. Otherwise, all information is kept confidential.
PAYMENT:
You agree to making payment prior to services rendered. All packages purchased must be used within a year of the original purchase date. If you do not pay, you understand that your account will be turned over to collections and reported to credit agencies. Refunds for coaching, mentoring, Reiki practitioner, and consulting services will not be provided - Except for an in approved circumstances. You will receive a payment notification by Venmo, may pay ahead by Venmo, PayPal, or Stripe. If discussed ahead of time - cash and check payments made out to "The Integrative Counselor LLC" may be accepted as well.
CANCELLATION, RESCHEDULING, & TERMINATION POLICY:
If you need to reschedule/cancel after your session has been scheduled, a $20 fee will be your responsibility to pay, if 5 or more business days away. If you need to reschedule/cancel less than 5 business days away, you will be charged for the full session. If two consecutive sessions are missed, services will no longer be provided. Termination of services may be decided by either client or Shannon Myers at any time. With all services, exceptions may be made on a case by case basis.
SCOPE OF PRACTICE & SERVICES:
Somatic Experiencing and Nervous System Retraining Coaching, Safe and Sound Protocol, The Reboot Group Coaching, Energy and Reiki Energy Services, Mentoring, Executive Coaching, Psychedelic Integration, Spiritually Transformative Experience Integration, Group practices, and Consultation services or any combination thereof are services for general educational & informational purposes only and do not constitute the practice of medicine, therapy, nursing, or other professional healthcare services. Including, the giving of medical advice, and no doctor/patient or therapist/patient relationship is formed.
Coaching, mentoring, Reiki energy services, consultation, and group coaching are comprehensive processes that may involve many areas of your life. Deciding on how to handle these areas and how to integrate coaching, mentoring, Reiki energy services, and consulting principles into those areas is exclusively your choice. No results are guaranteed, and any decision you take and any resulting consequences are solely your responsibility.
DISCLAIMER:The content of Shannon's website, social media, and services are not intended to be a substitute for professional medical advice, diagnosis, or treatment. All social media accounts are business accounts tied to Shannon Myers Consulting LLC and The Integrative Counselor LLC. You the user should not disregard, or delay in obtaining, medical advice for any medical condition you may have, and should seek the assistance of your healthcare provider(s) for any such conditions. Education or resources provided on Shannon's social media, website, and in coaching, mentoring, consultation, or Reiki practitioner services are for informational and educational purposes only.
Shannon's services can be used in addition to, complementary to, or alternative to the traditional medical model and mental health therapy, but are not a substitute for mental health therapy. If it fits your values and/or culture, you are invited to also work with a licensed mental health therapist, traditional medical model provider, and or any complementary/alternative health professionals. Shannon also does encourage you to have personal and professional supports in place through the coaching, mentoring, Reiki energy services, and consultation process.
Shannon Myers is not a Doctor or Licensed Mental Health Therapist. The use of information or materials provided during coaching sessions, group coaching, mentoring, reiki, psychedelic integration, group coaching, training, education, social media, her website, and consultation services is intended to educate, inform, and inspire you to embody and be your Authentic Self. They are not intended to replace or substitute any professional, medical, legal, or therapeutic advice.
Although Shannon is a Certified Rehabilitation Counselor, Certified Integrative Mental Health Professional, MAPS approved Psychedelic Integration Provider, Member of The American Center for The Integration of Spiritually Transformative Experiences, Reiki Master, Safe and Sound Protocol Practitioner, Somatic Experiencing Intermediate Level Practitioner--Shannon is working under the definition of Coach, Educator, Mentor, Consultant, and Reiki Practitioner. This means that she do not diagnose or treat any physical or mental condition, and that Shannon's coaching, mentoring, Reiki energy services, and consulting services are not a substitute for professional counseling or therapy. While Shannon may provide education, you are solely responsible for your own decisions, actions, and results. Shannon do not guarantee any specific outcome or result from her services. Your use of Shannon's service or services constitutes your acceptance of this disclaimer.
LIABILITY RELEASE:
By signing this form, you, or my legal guardian, are stating that you, or your legal guardian, am aware of your health conditions and you are voluntarily participating in coaching, mentoring, Reiki energy, or consulting services. Having such knowledge, you release Shannon Myers, Shannon Myers Consulting LLC, and The Integrative Counselor LLC from liability for illness or conditions which could incur as a result of participating in services. You hereby assume all risks connected and consent to participate. You agree to disclose any conditions in which may affect your ability to participate in coaching, Reiki energy services, mentoring, consulting, and or group coaching.
CONTACT INFORMATION:
If you have any questions, concerns, or complaints about the services or this consent form, please contact
Shannon Myers, MS, CRC, CIMHP Founder of Shannon Myers Consulting LLC and The Integrative Counselor LLC at her email: shannon@theintegrativecounselor@gmail.com or by phone: 1-515-981-6892.
AGREEMENT:
By signing this consent form, you acknowledge that you have read and understood the information above and that you agree to the terms and conditions of services. You also acknowledge that you have received a copy of this consent form for your records.
