Marriage Coaching Agreement Policy
Thank you for choosing Mudiwa LLC (4thisreason.org) for your relationship needs. Please read the Marriage Coaching Agreement Policy carefully and initial if you agree to the terms and conditions.
Note: Both partners must complete this agreement.
Relationship Coaching:
Marriage Coaching involves identifying current issues, creating a plan to help Clients move forward, and using tools and techniques that will help Clients get in touch emotionally and physically with their partners. Additionally, Marriage Coaching is for individuals who are emotionally and psychologically healthy. Specifically, Marriage Coaching is not a substitute for any mental health service and does not treat Client(s) with mental health illnesses and/or substance use disorders. Only a qualified doctor or psychotherapist is legally allowed to diagnose and treat clients with mental health illnesses.
Insurance:
The medical providers do not use diagnosis codes or CPT codes for Marriage Coaching, and because of this, Mudiwa LLC (4thisreason.org) does NOT participate, bill, complete forms for reimbursement or accept payment from insurance companies for the services received.
Payment:ALL PAYMENTS MUST BE PAID IN FULL AT THE TIME OF SERVICE unless a Split Payment Plan has been agreed upon prior to your first session. A $50.00 non-refundable deposit is required in advance to hold your first session, which can be paid via invoice or over the phone. Mudiwa LLC (4thisreason.org) only accepts payment in the form of cash, VISA, MasterCard, American Express or Discover. No checks are accepted.
Package Fees: Packages and prices may vary and are subject to change at any time. If prices should increase, prepaid packages will not change until the Client’s sessions are complete or if the sessions become null and void. The fee for ___________(insert amount of sessions) sessions is $__________. Upon completion of the package/sessions you may elect to continue individual sessions, sign up for another package, or consider a monthly maintenance plan.
Refund Policy:
ALL SALES ARE FINAL.
Mudiwa LLC (4thisreason.org) understands situations can change quickly when issues occur in relationships. Therefore, please consider all possible scenarios before proceeding with Marriage Coaching. Mudiwa LLC (4thisreason.org) is committed to Client satisfaction and is available to answer any questions or concerns you may have in regard to the services offered.
Cancellation Policy:
The Client(s) may cancel this agreement in writing at any time. The Coach may also cancel this agreement under the following circumstances, which are, including, but not limited to, Client(s) displaying inappropriate behavior, threaten to harm the Relationship Coach or another individual, speaks disrespectfully and/or makes derogatory remarks,does not call or show up (“No-Shows”) to scheduled sessions, excessively cancels sessions and/or is continuously late to sessions. There are no refunds if either the Client(s) or the Coach cancels this agreement.
Scheduling and Rescheduling Sessions:
Sessions cannot be scheduled longer than one month apart unless it’s arranged with the Coach. The idea of Coaching is to heal your relationship and make it stronger than before, which is why attending sessions more frequently is detrimental to the progress of your relationship. Therefore, if you do not see the Relationship Coach at least once every 30 days your remaining sessions will become null and void.
Rescheduling sessions is easy to do. However, rescheduling and/or canceling sessions represent a cost to the Relationship Coach, to you, and to other Client(s) who could have been seen in the time set aside for you.
Therefore, Mudiwa LLC (4thisreason.org) requires 24-hours notice for canceling or rescheduling sessions. If you cancel or reschedule your session in less than 24 hours OR if you excessively cancel your sessions consecutively (i.e. cancel two sessions in a row), but cancel within 24 hours there is a $50.00 cancellation fee. “No-shows” will forfeit their session. If the Client(s) are more than 10 minutes late for a session and they do not call to notify the Coach, the session will be canceled and the session will be forfeited (unless there is proof of an emergency).
Therefore, excessively rescheduling sessions or being late to sessions may result in
additional fees and/or discharge from Mudiwa LLC (4thisreason.org). For this reason, a credit card is required to remain on file. By initialing below you understand that you are responsible for any fees that may occur as a result of rescheduling, canceling in less than 24 hours, canceling consecutively with 24-hours notice, and /or not showing up to scheduled sessions. The Client(s), you, also understand and authorize Mudiwa LLC (4thisreason.org) to charge this fee to your credit card on file. If the card on file should expire you must provide updated information and pay any outstanding fees before scheduling your next session.
Session Times:
The first session is typically an hour and a half. The remaining sessions are 60-minutes (regardless if the Client(s) buy another package after finishing their first package). Sessions are conducted in person, by telephone, Zoom and/or FaceTime. The Client(s) agree to show up on time, call, Skype, and/or FaceTime the Relationship Coach at an agreed upon number or use the Skype ID provided. All sessions must start and end at the scheduled time to ensure it does not affect the Client(s) scheduled after you. If you are late, your session time cannot be extended. Arriving late will reduce your session time. If your session should exceed the scheduled session time, the Client(s) may be charged an additional fee.
Assignments and Goals:
Since the assignments and goals are customized for the Client(s), it maytake the Relationship Coach up to 48 hours before sending the Client(s) assignments and goals via email. The assignments and goals are given to the Client(s) during or after most sessions when applicable. All Clients are expected to participate and attempt to complete each assignment before their next session unless stated otherwise. It is the Client’s responsibility to review the attachments, print out the worksheets, and complete the assignments before their next session. Most assignments will be sent to the email address provided by the Client(s) on the New Client Information form. It is the Client’s responsibility to add Mudiwa LLC (4thisreason.org) as a known contact to their email OR to check their spam/junk folder for their assignments.If the Client(s) did not receive the email from the Relationship Coach, then it is the Client(s) responsibility to notify and inform the Relationship Coach after 48 hours. Failing to read and complete assignments may delay the progress of your goals and may affect the success of your outcome. Additionally, the Client(s) understands the privacy risks of sending and receiving electronic messages and will not hold the Relationship Coach responsible for emails that may contain personal content discussed during their session and/or solutions that are specific to the Client’s problems. These solutions are often discussed during sessions, but will act as a reminder to the Client(s) of what they need to work on. If the Client(s) prefer not to have an email sent they may opt out now or at any time. The Client(s) may take notes using a pen and notepad, but phones and other electronic devices are prohibited. If you would prefer to “opt out” please put your initials on the line and write “Opting Out” next to it.
Additional Support:
The Client(s) may e-mail OR call the Relationship Coach once in between each session. Emails should not take the Relationship Coach longer than five minutes to answer questions. Calls are based on availability and the Client(s) agree to keep the calls to five minutes or less. Additional fees may apply if the Client(s) exceed the time allotted. The Client(s) understand they cannot accumulate unused calls or emails to the Relationship Coach.
Guarantee:
As in any program, there is no guarantee. Results will vary based on each individual Client. However, this approach is very successful as long as the Client(s) are committed to their partner, the process, doing the assignments, using the tools they are given, and completing their customized sessions. Thus, by signing this agreement, the Client(s) do not hold the Relationship Coach responsible if the Client(s) cannot successfully resolve issues in their relationship.
Confidentiality:
Mudiwa LLC (4thisreason.org) will do their utmost to respect the Client’s right to privacy. However, the client-coach relationship is not protected if the Relationship Coach is ordered to testify in the court of law. Additionally, to ensure confidentiality and privacy, the use of any type of recording device by the Client(s) during sessions is strictly prohibited. This includes, but is not limited to the use of cameras, audio recording devices, computers and camera phones. Using these devices breaches the confidentiality rights of the Client(s) and infringes on the privacy rights of the Relationship Coach. Additionally, all conversations between the Client(s) and myself are documented and private. The Client(s) may request a copy of the New Client Information Form and the Relationship Agreement Policy for their records. However, notes taken during the Client(s) session by the Relationship Coach is prohibited.
Services Policy:
I understand that Mudiwa LLC (4thisreason.org) has the right to refuse and/or dismiss Client(s) from services at any time. I also understand that I may not be a candidate for Relationship Coaching and it is at my full discretion to determine whether I am a candidate for the services offered.Your signature on this agreement indicates you have read, understand and agree with the policy outlined above. If you do not agree and do not sign this agreement, you will not be able to proceed with the Relationship Coach and there will be a one-time fee of $150 for the time scheduled with the Relationship Coach.
