Symposiums, Seminars, Speaking Engagements, Workshops

Heart Mender Sessions and Coaching Contract

Client Name:

This agreement, between Heart Mender Specialist and Coach, Brenda D. Ballantine M. A. and the above named client will begin on ______ and will continue for a period of 3 months ending on ________, 2018. If said client desires to continue for additional length of time, current rates and time frames for each session will remain the same.


The fee for the initial phone consultation is free of charge, and the fee for the following sessions is $60.00 per hour.  These fees will be paid in advance. Alternatively, this is a quarterly package for a period of 3 months including 4 appointments per month for 60 minutes per session. Additional appointments can be scheduled as needed. If a need arises to cancel an appointment, please provide at least 24 hours’ notice or unfortunately, it may be necessary to charge for the appointment.


The services to be provided by the coach to the client are face-to-face or telephone-coaching, as agreed jointly with the client.  Coaching may address specific personal challenges, projects, business successes, or general conditions in the client’s life or profession.  Other coaching services include value clarification, brainstorming, identifying individual plans of action, examining the modes of operating in life, asking clarifying questions, and making empowering requests or suggestions for action.

Throughout the working relationship, the coach will engage in direct and personal conversations.  The client understands that successful coaching requires a co-active collaborative approach between client and coach.  In the coaching relationship, the coach plays the role of a facilitator of change, but it is the client’s responsibility to enact or bring about the change.

If the client believes the coaching is not working as desired, the client will communicate and take action to bring to the attention of the coach so that the coach may re-direct while moving forward in their working relationship.

The client will inform the coach if the client desires to add a spiritual component to the session, the coach will work within the agreed boundaries in that area.

 Prior History

The client also agrees to disclose details of the past or present psychological or psychiatric treatment.  Coaching and counseling are not the same and as such, there needs to be a clear distinction between the two.  Although I am a mental mental health profession, I will not be engaging in therapy per say with my coaching clients. All my training, education, skills, knowledge and tools will be combined to assist the client to achieve their highest potential and life goals.  In entering into the coaching relationship, and signing this agreement, there is the understanding the client agrees if any mental health difficulties arise during the course of the coaching relationship, the client will notify me immediately so that I can discuss, if needed an additional and appropriate referral.


The client can, at any point in the coaching session, declare his/her preference not to discuss a specific issue, by simply stating that they would rather not discuss this issue.  The coach agrees to respect this boundary and will not attempt to forward the conversation.


As a doctoral trained life coach, I will work within the professional ethics and guidelines as a coach, as well as all ethical guidelines in accordance with the American Psychological Association. All information about the coach / client relationship will remain strictly confidential except in very rare circumstances where decreed by law; ie. a court might issue a subpoena for my appearance.

If you wish for me, as your coach, to speak to someone outside our interactions, then you need to give me written permission (original letter, or email) to do so.  Exceptions to confidentiality of course relate to circumstances such as intent to seriously harm self or someone else, child abuse, or elder abuse. Otherwise, all your information is confidential.

It is also important to note that in some situations, it is important to be aware of the use of technology in that for some clients, there is a risk in using certain media such as the internet, mobile phones and cordless phones.  If you use these to communicate with me, then I will assume that it is appropriate to continue to do so in my interactions with you.


The coach and client agree to provide each other with two weeks’ notice in the event that it is desired to terminate coaching.  Otherwise, the coaching will continue for the duration of the contracted period.

I believe that each client is a unique, creative and responsible person who is in charge of moving their own life forward.  I look forward to working with you.

Our signatures on this agreement indicate full understanding of an agreement with the information outlined above.


____________________________                            _______________

Coaching Client                                                                                         Date


____________________________                            _______________

Executive & Personal Coach                                                                     Date


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