Rowland LTC Consent for Group Coaching
Welcome Packet
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Informed Consent, Policies and Rights

This packet is intended to inform you of the Group Coaching Services you will be receiving from Elevate Coaching and Consulting, LLC. Please feel free to contact me with questions regarding the below information at jen.elevate@pm.me

Description of Group Coaching:

Each group will last around 90 minutes. Our time together will promote a thought- provoking and creative process that inspires you to maximize personal and professional potential. You will have weekly actions steps to assist in working towards your goals. 

Information About Your Coach:

Jen Rowland  is a Licensed Counselor, National Certified Counselor and Certified Life Coach and Certified Behavioral Consultant.  She has been a business owner since 2009  and currently owns  Jennifer Rowland Counseling, LLC  and Elevate Coaching and Consulting, LLC.

My passion  is to empower men and women who are seeking a purposeful mid-course shift to uncover what endless WIDE- OPEN spaces await them and to equip them in navigating this new adventure shift with confidence and skill.

Confidentiality:

Jen Rowland  is working with you in the capacity of a Life Coach. However, she is currently a Licensed Professional Counselor in the state of Pennsylvania and is bound to these ethics of this profession. 

All information disclosed within sessions and the written/electronic records pertaining to those sessions are strictly confidential. Only by written permission will information be disclosed to a third party.  

A few exceptions are listed below:

•     If I have good reason to believe that you will harm another person.  If I believe that harm is imminent, I must attempt to inform that person and warn them of your intentions.  I must also contact the police and ask them to protect your intended victim.

•   If I have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give me information about someone else who is doing this, I must report this abuse or neglect Pennsylvania Childline or Adult Protective Services.

  • If I believe that you are in imminent danger of harming yourself, I may  break confidentiality and call the police or the county crisis team and or  911.
  • The admission to watching child pornography will also result in a report with the Pennsylvania Childline.

CONFIDENTIALITY OF  VIDEO, E-MAIL, AND CELL PHONE  COMMUNICATION

If we are unable to work in a face-to-face setting and contract to meet via video, or phone you understand that every effort will be made to ensure those communications remain confidential.  However, you also accept some measure of risk inherent in the use of these technologies.  

Cancellation:

The scheduling of services involves the reservation of time specifically for you; a minimum of a 24-hour notice is expected for re-scheduling or canceling our meetings.  If a meeting is missed forfeit of payment allotted to that meeting will occur.  If you are having concerns about meeting times please feel free to talk this over with your coach, there may be alternate options for you. 

Termination:

The client acknowledges that he/she may terminate or discontinue the coaching relationship at any time.
The client acknowledges that coaching does not involve diagnosing or treating mental disorders as defined by American Psychiatric Association and that coaching is not to be used as a substitute for mental health counseling, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals. 
Referrals for mental health counseling, and or substance abuse treatment can be provided if it becomes clear to your coach that greater support is necessary to aid in your personal growth. 

Please feel free to discuss any of the above information with me at any phase of our working together. 

I have read and accepted this document. *
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