Coaching Form

Be Here Now Mindfulness, LLC Coaching Program

Consent to Participate, Release, and Waiver of Liability

Read the below consent to participate, release, and waiver, and then print, sign, and submit it to Be Here Now Mindfulness, LLC. Participants in Be Here Now Mindfulness, LLC Coaching Services must understand and complete this waiver in order to begin coaching. If you do not understand or agree to the waiver or have questions about it, please contact Be Here Now Mindfulness, LLC, before your first session.

I, the undersigned, consent to participate in Be Here Now Mindfulness, LLC Coaching and accept full responsibility for my health and voluntarily complete this Consent to Participate, Release, and Waiver of Liability. I agree to enter this consent, release, and waiver of liability.

I understand and agree that the services and tools offered by Be Here Now Mindfulness, LLC Coaching are not intended to replace or be a substitute for medical or psychiatric care. Be Here Now Mindfulness, LLC Coaching is not a therapeutic intervention for any disorders identified in the Diagnostic and Statistical Manual of Mental Disorders or any other medical reference and is not intended to be used as such. I acknowledge that the coaching process may, at times, make participants feel uncomfortable or vulnerable. By completing this consent, release, and waiver of liability, I assume all risks for any physical or mental consequences of participating in the coaching services offered at Be Here Now Mindfulness, LLC.

By signing this consent, release, and waiver of liability, and in consideration for Be Here Now Mindfulness, LLC allowing me to participate in the coaching program, I also specifically and expressly agree to hold harmless, indemnify, and release Be Here Now Mindfulness, LLC, and all training staff, and their respective employees, collaborators, agents, associates, and affiliates from any and all liability arising from my participation or arising from the results of the educational guidance and other content that will be or has been provided in the Coaching program.

I also acknowledge and agree that any personal information shared in the Be Here Now Mindfulness, LLC Coaching program is to be maintained as confidential. I also understand that sessions might be conducted via online platforms that are not necessarily HIPAA contracted, and I consent to meeting with such modes of communication. Technology is constantly changing, and if there are any implications to this agreement that we may not realize at this time, I understand that I can withdraw my authorization to meet online or with suggested platforms by notifying Be Here Now Mindfulness, LLC either in writing, asking questions, or simply stating to my coach at any time.

I further acknowledge and agree that participating in this Coaching program does not entitle participants to i) teach or further distribute any content presented or ii) represent themselves as sponsored by or otherwise affiliated or connected with Be Here Now Mindfulness, LLC

I understand that Be Here Now Mindfulness, LLC may terminate my participation in the Coaching program: (i) at any time in its sole discretion or (ii) if I violate the terms of this agreement or Be Here Now Mindfulness, LLC Policies or Procedures.

I have read this document carefully, and I consent to and voluntarily choose to participate in the Be Here Now Mindfulness, LLC Coaching program described herein. I certify that I am at least 18 years of age, I am legally competent, and I am signing this document with full knowledge that it is a legally binding agreement under Georgia law.

PLEASE SIGN AND COMPLETE THE ELECTRONIC FORM BELOW TO ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE INFORMATION DESCRIBED HEREIN AND THAT YOU HAVE DISCUSSED WITH ME ANY PART OF THE INFORMATION YOU DO NOT UNDERSTAND.

THE ORIGINAL COPY OF THIS DOCUMENT WILL REMAIN IN MY FILE; FOR A PERSONAL COPY, YOU ARE RESPONSIBLE FOR PRINTING ON YOUR OWN.

I UNDERSTAND THE FINANCIAL POLICY. I ALSO UNDERSTAND THAT THIS PROVIDER IS NOT ON INSURANCE PANELS AND DOES NOT FILE INSURANCE CLAIMS.