CONSENT TO INDIVIDUAL VIRTUAL COACHING SESSIONS BY Rebecca E Stone LLC

The service that we wish to offer you is specialized online group coaching related to healing from infidelity in intimate relationships. Coaches at Rebecca E Stone LLC (“Stone”),
a Pennsylvania Limited liability company will provide somatic coaching services to clients
on relationship issues, life stressors, and healing from maladaptive beliefs and mindset issues is not a medical, mental health or any other type of health service. It is not psychotherapy or mental health counseling. No diagnosis or treatment of, or advice
regarding, any medical or mental health condition or illness is offered. Health insurance companies do not reimburse for coaching services. Coaching cannot substitute for, and is not an alternative to, medical or other healthcare diagnosis and treatment when a medical
or mental health condition or illness is present. Health insurance companies do not reimburse for coaching services. Individuals are advised to seek diagnosis, treatment and advice regarding medical or mental conditions or illnesses from physicians and other licensed health care and mental health professionals. If you wish for a mental health assessment, counseling or psychotherapy for symptoms related to mental illness, then we can provide you with referrals at your request.
Stone coaches all hold Masters degrees in Social Work and Mental Health Counseling. Although Stone coaches are licensed as mental health professionals in
Pennsylvania and New York State, coaching is not considered a health care service for which licensure is required. That our coaches have professional license does not mean that our coaching services are necessarily superior to the services of unlicensed coaches.
Coaching for this program is provided by: Rebecca Stone.
The individual Coaching package offered by Stone is focused on infidelity recovery.

The fee per session is $350. Fees for all coaching sessions must be paid either prior to or
immediately after the session. Services not paid for in advance will not be provided. If you
cancel your attendance at a coaching session with at least 48 hours notice, then you will be
charged the full fee for the session. There are no refunds of fees paid.
Stone is ethically bound to protect the confidentiality of your communications with
us. We will only release information about our work to others with your written permission or in response to a court order. There are some situations in which we may be
legally obligated to break confidentiality in order to protect you or others from harm.
These situations are quite rare. If such a situation occurs, we will make every effort to discuss it with you before taking any action.
As you are no doubt aware, it is impossible to protect completely the confidentiality of information that is transmitted electronically. This is particularly true of information
stored on computers that are connected to the internet.

By signing this agreement, you commit yourself to maintaining the confidentiality of all information communicated to you by your coach.
Please sign below indicating that you understand the nature of the coaching services that Stone offers, and that you have had the opportunity to ask any questions you might have about Stone and the services it is providing to you.

Fees for the group coaching package must be paid in advance by credit card or in agreed upon installments based on our payment plan. 

Services not paid for in advance will not be provided. There are no refunds of fees paid. If you cancel your attendance at a coaching session, then you will be provided with a recording of the session that you missed.