Informed Consent
Coaching services delivered by Roxana Karimi utilizing skills appropriate for aid with personal growth and development is meant to challenge, uplift, assist, grow, and support you.
It is imperative to understand that coaching services are not psychotherapy.
Disclaimer: Coaching services are not a substitute for therapy. The difference between therapy and coaching is that therapy is based on a clinical approach to aid with emotional challenges. Coaching is more directive with guidance and assistance to focus on personal goals for overall balance and wellness in life.
Insurance: Due to the nature of coaching not being considered a medical service and or necessity, insurance will not cover the cost.
Acknowledgment of below terms is required to continue. Should you agree to each statement and wish to proceed with coaching services:
● Although my coach is a licensed psychotherapist, I understand that I am NOT RECEIVING THERAPY services. Additionally, I understand that I am working together with my coach on non-clinical aspects or of my wellbeing that are not of medical concern for mental health. Additionally, I am aware that my coach will not provide me with a diagnosis or provide counseling, psychotherapy, psychoanalysis, professional mental health care or substance abuse treatment as defined by the American Psychiatric Association or Board of Behavioral Sciences.
● I understand that my communications with my coach will be held confidential to the extend established by the laws of the states and or country in which each of us resides.
● I understand and agree that I am fully responsible for my overall well-being during the time I receive coaching services that include my decisions, actions, and behaviors.
● I understand that all feedback, recommendations, and or suggestions offered by my coach are solely for the purpose of assisting me in achieving my established goals. Additionally, I am cognizant of the decision to give my informed consent to my coach to provide me guidance and assistance in achieving my goals.
● I hereby release, waive, acquit, and forever discharge Roxana Karimi, Roxana Karimi Licensed Marriage and Family Therapy Inc, and or their agents, successors, assigns, volunteers, vendors, personal representatives, executors, heirs and employees Roxana Karimi, from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of actions, omissions, or commissions taken by myself or as a result of the recommendations given by Roxana Karimi otherwise resulting from the coaching relationship contemplated hereunder.
I have read the statements above and I understand and agree with the information contained therein. Moving forward with coaching services from Roxana Karimi this is my acknowledgement and acceptance of all statements contained above.
You will be contacted to schedule your appointment after payment has been made.
I look forward to your rising 💫
Terms and Conditions
Term of Agreement
This term of this Agreement shall begin as of the Effective Date and remain in full force ongoing like a gym membership, or until otherwise terminated pursuant to the provisions of this Service Agreement.
Compensation
Service Provider will notify Customer about the available methods to render payment and will provide any other information necessary to effectuate payment. Compensation is due and payable on the Effective Date, unless otherwise specified by the Service Provider. If the client does not pay in full, the price of the program may increase at service providers discretion.
Furthermore, I authorize charges to my debit card/credit card used for the payment of Roxana Karimi Licensed Marriage and Family Therapy Inc. I will be charged the amount indicated for services as previously agreed upon. A receipt for payment can be provided via email request to r[email protected] and/or teachable service.
Additionally, disclosure of information such as name and payment amount are made to processing and banking institutions for payment. Additionally, accounting staff with Roxana or Roxana Karimi Licensed Marriage and Family Therapy Inc. may also come into contact with payment information for billing and accounting purposes.
Furthermore, for outstanding payments of services rendered, I authorize Roxana Karimi Licensed Marriage and Family Therapy Inc to charge my credit card/debit card for the remaining balance due.
Additionally, I acknowledge I agree to not dispute charges and that the origination of transactions to my card must comply with the provisions of U.S. law. I certify that I am an authorized user of this card or have been granted permission to use this card for payment and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this agreement
Confidentiality and Non-Disclosure
Confidential Nature of Information. Customer agrees to treat all information obtained from The Conscious Healing Program in the performance of this Agreement, including but not limited to the online content, Customer’s log-in credentials (such as username and password), as confidential and proprietary to Heal Your Inner Child and Roxana Karimi. Customer shall treat all records, information, and work-product prepared, shared, or maintained by Roxana and Heal Your Inner Child and its employees, agents, and representatives in the performance of this Agreement as confidential and will not disclose this information to any other persons, social media platforms, firms, or organizations by any means. Further, nothing in this Agreement or in the performance of this Agreement shall be construed as granting or conferring any rights by license, express or implied, regarding any idea made or conceived by Service Provider, nor as granting any right with respect to the use or marketing of any product or service of Service Provider.
Survival. Customer’s obligations under this paragraph shall survive the termination of this Agreement.
Releases of Liability
The Customer agrees to hold the Service Provider, its officers, employees, or agents, harmless from any loss, claim, damage, or liability of any kind involving an officer, employee, or agent of the Service Provider arising out of or in connection with this Agreement. In no event shall Service Provider, including but not limited to Service Provider’s principals, employees, agents, or contractors, be liable to Customer, or any third party, for any loss of profits, loss of business, or indirect, incidental, special, consequential, exemplary, or punitive damages arising out of or related to this Agreement.
No Warranties
The Service Provider makes no warranties, express or implied, as to any matter whatsoever, including, without limitation, the condition or quality of the services described herein, whether tangible or intangible, or developed under this Agreement; or the marketability, or fitness for a particular purpose of the services. The Service Provider shall not be liable for any direct, indirect, consequential, special, or other damages suffered by any person resulting from this Agreement or the Customer’s use of the Service Provider’s services or information.
Relationship of the Parties
This Agreement does not create, nor shall be represented by either party hereto to create, a partnership, joint venture, employer-employee, master-servant, principal-agent, or other relationship whatsoever between the Parties hereto.
Governing Law and Venue
This Agreement, the rights of the Parties hereunder, and any disputes arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the State of California.
Dispute Resolution
The Parties shall attempt in good faith to resolve any dispute arising out of or relating to this Agreement promptly by negotiation between the Customer and an authorized executive from the Service Provider to settle the controversy. Any party may give the other party written notice of any dispute not resolved in the normal course of business. Within ten (10) business days after the delivery of the notice, the receiving party shall submit to the other a written response. The notice and response shall each include with reasonable particularity a statement of the party’s position(s) and a summary of arguments supporting that position(s). Within thirty (30) days after delivery of the notice, the Parties shall meet at a mutually acceptable time and place, which can include via telephone or video conference.
Unless otherwise agreed in writing by the negotiating Parties, the above-described negotiation shall end at the close of the first meeting described above (“First Meeting”). Such closure shall not preclude continuing or later negotiations, if desired.
All offers, promises, conduct and statements, whether oral or written, made in the course of the negotiation by any of the Parties, their agents, employees, experts and attorneys are confidential, privileged and inadmissible for any purpose, including impeachment, in arbitration or other proceeding involving the Parties, provided that evidence that is otherwise admissible or discoverable shall not be rendered inadmissible or non-discoverable as a result of its use in the negotiation.
At no time prior to the First Meeting shall either side initiate an arbitration or litigation related to this Agreement except to pursue a provisional remedy that is authorized by law or by agreement of the Parties. However, this limitation is inapplicable to a party if the other party refuses to comply with the requirements of this section.
All applicable statutes of limitation and defenses based upon the passage of time shall be tolled while the procedures specified in the aforementioned paragraphs of this section are pending and for 15 calendar days thereafter. The Parties will take such action, if any, required to effectuate such tolling.
If any dispute, claim, or controversy is not resolved between the Parties through the aforementioned process, then any dispute, claim or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this Agreement to arbitrate, shall be determined by arbitration in California. The Parties shall maintain the confidential nature of the arbitration proceeding, including the hearing, except as may be necessary to prepare for or conduct the arbitration hearing on the merits, or except as may be necessary in connection with a court application for a preliminary remedy, or unless otherwise required by law or judicial decision. In any arbitration arising out of or related to this Agreement, the arbitrator(s) shall not award costs or attorneys’ fees. For any dispute arising out of or relating to this Agreement, each party is to bear their own costs and attorneys’ fees.