Mary’s Counselor’s Couch

Emotional Wellness & Personal Development

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Legal Agreement

Informed Consent for Emotional Wellness Services

Please read this carefully before engaging in services with Mary's Counselor's Couch.

This Informed Consent Agreement ("Agreement") describes the nature of the emotional wellness services provided by Mary ("Practitioner") and outlines important information about the services, limitations, confidentiality, and your rights and responsibilities as a client.

By engaging in services with the Practitioner, you acknowledge that you have read, understood, and agree to the terms outlined in this Agreement.

Nature of Services

Non-Medical Coaching Services

The services provided by Mary are emotional wellness and life coaching services only. These services are not:

Psychotherapy, counseling, or mental health treatment
Medical treatment or medical advice
Psychiatric evaluation or treatment
Diagnosis or assessment of mental health conditions
Crisis intervention or emergency mental health services
A substitute for treatment by a licensed mental health professional

Services Include

Emotional wellness coaching and guidance
Life coaching and personal development
Leadership and executive coaching
Communication skills development
Relationship guidance and coaching
Stress management and resilience coaching
Career development support
Personal transformation and self-discovery

Practitioner Boundaries & Qualifications

Not a Licensed Mental Health Professional

Mary is not a licensed therapist, psychologist, psychiatrist, or medical doctor. She does not hold mental health licenses or certifications from medical boards.

Professional Background

Services are provided based on professional coaching training, lived experience, and specialized knowledge in emotional wellness and personal development. This is different from and not equivalent to clinical training or licensure.

No Doctor-Patient or Therapist-Client Relationship

Using these services does not create a doctor-patient relationship, therapist-client relationship, or medical relationship. You retain full responsibility for your own health and well-being.

Scope of Practice

The Practitioner will work within the scope of coaching services. If concerns arise that fall outside this scope, the Practitioner will recommend that you seek appropriate professional care.

Client Responsibilities

By engaging in these services, you agree to the following responsibilities:

▪You are responsible for your own physical and mental health care. These services do not replace care from qualified medical or mental health professionals.
▪You will inform the Practitioner if you have a diagnosed mental health condition, are currently in therapy, or are taking psychiatric medications.
▪You will seek immediate professional help if you experience thoughts of self-harm, suicide, or harm to others.
▪You will make your own informed decisions about whether these services are appropriate for you.
▪You will communicate openly and honestly about your needs, concerns, and any changes in your situation.
▪You understand that results are not guaranteed and depend largely on your own effort, engagement, and willingness to apply what you learn.
▪You will not hold the Practitioner responsible for outcomes that depend on your choices and actions.
▪You agree to honor agreed-upon session times and to provide notice if you need to reschedule or cancel.

Confidentiality & Limits

Confidentiality Protection

The Practitioner respects the confidentiality of your information and will not share personal details discussed during coaching sessions without your written consent, except as required by law.

Important Limitation: No Legal Protection

These coaching services are NOT protected by therapist-patient privilege or attorney-client privilege. This means:

Communications may not be legally confidential in all circumstances
The Practitioner may be legally compelled to disclose information in certain situations
Your information may not have the same legal protection as information shared with a licensed therapist

Required Disclosures

The Practitioner may be required by law to disclose information if you disclose:

▪Threat of harm to yourself (self-harm or suicide)
▪Threat of harm to others
▪Child abuse or neglect
▪Elder abuse or vulnerable adult abuse
▪Information required by court order or subpoena

Crisis Protocol

These Services Are NOT Crisis Services

If you are in crisis, experiencing thoughts of self-harm or suicide, or having a mental health emergency, do not rely on these coaching services. Immediately contact:

• 911 (USA) or your local emergency number

• National Suicide Prevention Lifeline: 1-800-273-8255 (24/7)

• Crisis Text Line: Text HOME to 741741 (24/7)

• Go to your nearest emergency room

If Crisis Occurs During Coaching

If you enter a crisis state during or between coaching sessions, the Practitioner will:

Encourage you to immediately contact emergency services (911)
Provide crisis line numbers and resources
Suggest you seek care from a mental health professional or emergency provider
May recommend pausing coaching services until you are stabilized with appropriate professional care

Potential Risks & Benefits

Potential Benefits

Increased emotional clarity and self-awareness
Improved decision-making and life direction
Enhanced communication skills
Greater resilience and stress management
Strengthened relationships
Enhanced leadership effectiveness
Personal growth and transformation

Potential Risks

Temporary increase in emotional intensity or discomfort
Potential relationship changes as you develop and grow
Possibility that results differ from expectations
Risk if used instead of professional mental health care
No guarantee of specific outcomes

Your Acknowledgment

By engaging in services with Mary's Counselor's Couch, you acknowledge that:

You have read and understood this Informed Consent Agreement
You understand that these are coaching services, not medical or mental health treatment
You understand that Mary is not a licensed mental health professional
You understand the limits of confidentiality and when the Practitioner may be required to disclose information
You take full responsibility for your mental and physical health
You will seek professional mental health or medical care when needed
You will immediately contact emergency services if you are in crisis
You will not hold the Practitioner liable for outcomes resulting from your choices and actions
You have had the opportunity to ask questions and discuss any concerns

Questions? Contact Mary

If you have any questions about this agreement or whether these services are right for you, please reach out before engaging.

Contact Mary