1. INFORMED CONSENT
This form consists of two parts.
The first part outlines the terms of our collaboration. Please read them carefully. By providing your digital signature below, you agree to the terms stated above.
In the second part, I would like to ask you to answer a few questions prior to our first session. Your responses will help me prepare more effectively for our meeting and make the best use of our time together. They will give me a better understanding of the issues you are bringing to the session, allowing me to prepare more thoroughly. You may answer the questions briefly or in greater detail—the choice is entirely yours.
1. WHAT IS IFS (INTERNAL FAMILY SYSTEMS)
Internal Family Systems (IFS) is a therapeutic approach based on the premise that our mind consists of multiple parts, each with its own role and function. These parts can be wounded, protective, or healthy, and together they form our inner world. The goal of IFS is to connect with one's "Self"—a source of calm, compassion, and wisdom. Through the Self, we can heal wounded parts, reduce internal conflicts, and achieve greater harmony and balance in life. The Self exists within everyone; it cannot be damaged and knows how to heal.
2. RESPONSIBILITY
My services do not replace the diagnosis and/or treatment of medical or mental health conditions. I am not a licensed psychotherapist, psychologist, or physician, and I do not provide psychotherapy or medical care. I do not diagnose or treat medical or mental illnesses, nor am I authorized to do so. The client acknowledges that the services provided are not intended to prevent, cure, or treat any mental disorder or illness requiring the intervention of a trained psychiatrist, psychotherapist, or healthcare provider.
3. SCOPE OF PRACTICE
The coach/facilitator is not and will not be held liable for any actions, inactions, or direct or indirect consequences resulting from the services provided. Making any choices is the sole responsibility of the client. It is the client's sole responsibility to seek appropriate independent professional, medical, or psychiatric advice or services if needed. 4. PROFESSIONAL RECORDS
I keep brief records of each session, noting primarily the date, obstacles, and progress regarding your goals or issues. I store your records in a secure location inaccessible to anyone else.
I will retain your records for three years following our last contact, after which I will securely destroy them.
I acknowledge that either party may terminate or suspend the coaching relationship at any time, should either party deem it necessary.
4. PROFESSIONAL RECORDS
I keep brief records of each session, noting primarily the date, obstacles, and progress regarding your goals or issues. I store your records in a secure location inaccessible to anyone else.
I will retain your records for three years following our last contact, after which I will securely destroy them.
I acknowledge that either party may terminate or suspend the coaching relationship at any time, should either party deem it necessary.
5. CONFIDENTIALITY
You have an absolute right to the confidentiality of your therapy. Therefore, I cannot and will not disclose to anyone what you have told me—or even the fact that you are attending sessions with me—except in cases defined by law.
At times, it may be beneficial to consult other professionals regarding a case. However, I avoid revealing the client's identity during such consultations.
6. FEES AND REFUND POLICY
Current rates and session durations are listed on my website. If you need to cancel or reschedule a session, you must do so at least 24 hours in advance. Otherwise, the full session fee will be charged.
If you purchase a package of 3 or 5 sessions, it is valid for a limited time. A 3-session package is valid for 3 months from the date of purchase, and a 5-session package is valid for 5 months from the date of purchase.
All coaching sessions and session packages are non-refundable.
If you are new to Internal Family Systems (IFS) or unsure whether working with me is the right fit, I recommend booking a single 1:1 sessions before purchasing a package. This gives you the opportunity to experience the approach and decide whether you'd like to continue with a longer commitment.
7. OTHER PROVISIONS
I understand, acknowledge, and accept the coach/facilitator's current level of experience and training.
By signing and submitting the questionnaire below, I confirm that I have completed the questionnaire, read the information in this document, fully understood it, and agree to abide by the stated terms and conditions throughout our collaboration.