How Are Things Going?

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Hello! We're excited to partner with Cedar Creek Ministries and look forward to serving you well! Please answer the following questions and share how things are going in your life right now and then we will talk about making improvements during our call together!

When rating yourself, please use a scale from 1-10 (1=You're Stressed and 10= You're Doing Very Well).

Email *

Your First and Last Name *

Best Number To Reach You At *

Best Days and Timeframes For A Call (30-45 Minutes) *

How are you doing physically (rested, eating, sleeping, exercising) *

Stressed

Doing Very Well

How are you doing emotionally (calm, relaxed, having fun, supported)? *

Stressed

Doing Very Well

How are you doing mentally (calm, stimulated, engaged)? *

Stressed

Doing Very Well

How are you doing spiritually (connected, growing, peaceful, etc)? *

Stressed

Doing Very Well

How are things going financially? *

Stressed

Doing Very Well

How are things going at home? *

Stressed

Doing Very Well

How are things going at work? *

Stressed

Doing Very Well

From the reflections above, who do you want to enjoy more? *

What other areas do you want to improve?

Agreement Between You (Client) and Us (Blessed Leaders). Please check all of the boxes if you agree to the terms listed. Thanks! *

First and Foremost- Thank you for trusting us to serve you. We promise to treat you kindly and with respect. We hope you will do the same for all of our team members.

Privacy and Confidentiality- All information shared will be held as confidential unless we state otherwise, in writing, except as required by law. We will not share information to third parties paying for sessions including parents, guardians, or employers unless the client gives us permission to do so.

Sessions- Each session will be centered around what you want to improve and work on. For maximum results, it's important to come on time and be prepared with updates, progress, and current challenges. It's equally important for you to follow through with commitments.

Changes- We will give you 24 hours notice if we need to cancel or reschedule. Please do the same for us. If you do not call or show up, you will billed for half the amount of the regular investment per session. If this occurs on multiple occasions, we reserve the right to postpone or end the Professional-Client relationship

Payment/fees- Payments are due at the time of service. Prices are negotiated and vary based on location, frequency and duration. We accept cash, checks made out to ILC, or credit cards. Please note you will be responsible for paying your own expenses such as food, travel, or long distance calling charges, if any. ILC is a private business and not able to accept any insurance policies.

Problems- We want you to be satisfied! If anyone at ILC ever says or does something that upsets you or doesn't feel right, please bring it up. We promise to take you seriously and do our best to resolve any problems. You may contact our human resource department Monday through Friday between 9:30 am to 4:30 pm at 865-446-0353 or email us at enjoymore@improvinglifecenter.com.

Agreement- As a client, I understand and agree that I am fully responsible for my physical, mental, and emotional well being during sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time. I recognize that coaching is not psychotherapy and that professional referrals will be given if needed.

I understand that "coaching" is a Professional-Client relationship I have with my coach that is designed to facilitate the creation/development of personal, professional or business goals and to develop and carry out a strategy/plan for achieving those goals.

I understand that coaching is a comprehensive process that may involve all areas of my life, including, but not limited to work, finances, health, relationships, education and recreation. I acknowledge that deciding how to handle these issues and implement my choices are exclusively my responsibility.

I understand that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association. I understand that coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment and I will not use it in place of any form of diagnosis, treatment, or therapy.

I promise that if I am currently in therapy or otherwise under the care of a mental health professional, that I have consulted with this person regarding the advisability of working with a coach and that this person is aware of my decision to proceed with the coaching relationship.

I understand that information will be held as confidential unless I state otherwise, in writing, except as required by law.

I understand that coaching is not to be used as a substitute for professional advice. I will seek professional guidance for legal, medical, financial, business, spiritual or other matters. I understand that all decisions in these areas are exclusively mine and I acknowledge that my decisions and my actions regarding them are my sole responsibility.

If I am paying for someone else’s coaching sessions, I’m considered a third party. I consent to waive my right to any confidential information shared during coaching sessions between the Client and Professional Coach.

Required

A copy of your responses will be emailed to the address you provided.

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