Consent* I AGREE WITH THE INFORMED CONSENT FOR REMOTE COACHING & CONSULTING SERVICES
INFORMED CONSENT FOR REMOTE COACHING & CONSULTING SERVICES
REMOTE COACHING & CONSULTING
Remote coaching and consulting involve the use of electronic communications such as telephone, audio, video, email, chat, messaging and/or other forms of remote communication in order to enable Self Relativity, Inc. and Dr. Vahé Ohanessian to connect with individuals using such electronic communications.
Remote coaching and consulting include the practice of advising, consulting and coaching based on the experiences, opinions and thoughts of Dr. Ohanessian with the client(s). Coaching and consulting may address specific personal struggles, business issues, or general conditions in the client's life or profession. Other coaching and consulting services include value clarification, brainstorming, identifying plans of action, examining models of operation in life, asking clarifying questions, and making empowering requests or suggestions for action. Additionally, the client may be asked to reflect on difficult topics or situations which may result in expressions of emotions especially difficult and negative emotions.
Throughout the working relationship, Dr. Ohanessian will engage in direct and personal conversations. The client understands that successful coaching and consulting requires collaborative approach between client and Dr. Ohanessian. In the coaching and consulting relationship, Dr. Ohanessian engages in the role of a facilitator of change, but it is the client's responsibility to enact best methods whether advised or consulted by Dr. Ohanessian or not in order to bring about the change. It is the client’s responsibility to evaluate all options including advice and suggestions made by Dr. Ohanessian, to their own suitability and specifics of life. If the client believes the coaching and consulting is not working as desired, the client should communicate this with Dr. Ohanessian as soon as possible so that a proper path forward could be decided and implemented.
As the client(s), I understand and agree that:
I have read and understand the disclaimer section at www.SelfRelativity.com and its relevance with this consent form. Therefore, by using this website (www.SelfRelativity.com) or any information on it, including but not limited to podcast, blogs, videos, audios, social media posts, products and services including remote or in person coaching and consulting sessions; I acknowledge that I have read and agree to the terms in both the disclaimer and this consent form. I further agree that if I do not agree with these terms, I shouldn’t be using the website nor its information, products and/or services and I shouldn’t be requesting, paying and engaging in coaching and consulting sessions with Dr. Ohanessian.
The laws that protect the confidentiality of my personal information also apply to remote coaching and consulting. As such, I understand that my history and/or the information disclosed by me during the course of my sessions is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality, including, but not limited to, reporting child, elder, and dependent adult abuse; expressed threats of violence toward an ascertainable victim; and where I make my mental or emotional state an issue in a legal proceeding. I also understand that the dissemination of any personally identifiable images or information from the remote coaching and consulting interaction to other entities shall not occur without my written consent.
Prior History: I agree to disclose details of the past or present psychological or psychiatric problems and/or treatments. Coaching and consulting are not the same as counselling; therefore, therapy and other modes of professional or medical psychological examination shall not be considered equivalent to coaching and consulting.
I understand that Dr. Ohanessian is not a registered psychologist or psychiatrist, nor a licensed therapist. Dr. Ohanessian does not engage in therapy or counselling with his coaching and consulting clients. In entering into the coaching and consulting relationship, and by signing the agreement, I am agreeing that if any mental health difficulties arise during the course of the coaching relationship, I will notify Dr. Ohanessian immediately so that he can discuss with me an appropriate or alternative course of action.
I understand that there are risks and consequences from remote coaching and consulting, including, but not limited to, the possibility, despite reasonable efforts on the part of Self relativity, inc. and Dr. Vahé Ohanessian, that: the transmission of my personal information could be disrupted or distorted by technical failures, the transmission of my personal information could be interrupted by unauthorized persons, and/or the electronic storage of my personal information could be unintentionally lost or accessed by unauthorized persons. Self Relativity, Inc. utilizes secure, encrypted audio/video transmission software to deliver online coaching and consulting.
I understand that if Dr. Vahé Ohanessian believes I would be better served by another form of coaching, consulting or intervention; I will be responsible to transfer to other coaches and consultants and/or to other mental health professional that can provide such services for me, Dr. Ohanessian will not provide any referral services. I furthermore understand that there are potential risks and benefits associated with any form of coaching and consulting, and that despite my efforts and the efforts of Dr. Ohanessian, my situation and/or its associated conditions may not improve, and in some cases may even get worse.
I understand that there are alternatives to remote coaching and consulting and in choosing to participate in remote coaching and consulting, I am agreeing to participate using recommended communication method(s). I also understand that at my request or at the recommendation of Dr. Ohanessian, I may have to find alternative sources for my conditions and/or preferences.
I understand that although the goal is to benefit from remote coaching and consulting; my expectations of the anticipated benefits may not be achieved and that no results can be guaranteed or assured.
I understand that if I wish for Dr. Ohanessian as my coach and consultant to speak to someone outside our interactions, I need to give a written permission in order for him to do so; however, I also understand that it will ultimately be up to Dr. Ohanessian’s decision whether he would choose to discuss my situation with others that I authorize.
I understand that my information and history may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than Dr. Ohanessian in order to operate and assist in the operation of the electronic communication for example, operation of video equipment. Such additional entities will maintain confidentiality of the information obtained. I further understand that I will be informed of their presence in the coaching and consultation session and I will thus have the choice to accept or terminate the session.
I understand that my express consent is required to forward my personally identifiable information to a third party.
Prices & Termination: I understand that I have the option to terminate the coaching and consulting relationship by a 24-hour notice. I understand that if I do not cancel within 24 hours prior to my session, I will be responsible for the full cost of the session and my session will automatically be cancelled if payment is not received 24 hours prior to the time of the session. The “launch introductory” cost for each session is $400 for a 50-minute session or $600 for a 75-minute session. These prices are at 50% introductory discount to the regular prices for 1-on-1 sessions with Dr. Ohanessian; the author of Theory of Self-Relativity. I understand that the 75-minute session is recommended because longer uninterrupted sessions are considered to be more productive. I further understand that I can advance purchase a package of five 50-minute sessions for a discounted total price of $1,750 (a saving of $250) or a package of five 75-minute sessions for a discounted total price of $2,500 (a saving of $500). I further understand that the packages must be purchased in advance in full and the sessions of the packages are good for a period of one-year from the date of purchase and the unused portion will expire at that time. There will be no refunds or prorated partial refunds for packages purchased but not used and/or expired. The purchased packages are not transferrable. I also understand that individual and session package prices are subject to change without notice however if I have already paid for individual session(s) and/or for packages prior to change in price, the prepaid prices will be honored as long as the terms have not expired.
By signing this document, I agree that certain situations, including emergencies and crises, are inappropriate for coaching and consulting services, especially remote coaching and consulting services. If I am in crisis or in an emergency, I should immediately call 9-1-1 or seek help from a hospital or crisis-oriented health care facility in my immediate area.
PAYMENT FOR REMOTE COACHING AND CONSULTING SERVICES
Payment for remote coaching and consulting services is due 24 hours prior to the time of service and must be paid electronically via PayPal. Payments must be made 24 hours in advance of the time and date of the session so that your appointment session will be reserved for you. If payment is not made within 24 hours of session, your appointment will be cancelled. All payments are non-refundable in order to guarantee non-cancellation and/or no-shows at the time of the session.
RELELASE OF LIABILITY
Coaching and consulting is a service that provides personal coaching and consulting to specific individuals and/or groups. The client is aware that coaching and consulting are in no way to be construed or substituted as psychological counselling or any other type of therapy or medical advice. Dr. Vahé Ohanessian will at all times exercise his best efforts, skills and care of ensuring his client(s) is coached to meet their coaching and consulting goals. The client understands and acknowledges that Dr. Ohanessian will not be liable legally or otherwise, for the actions the client may or may not undertake as a result of the coaching and consulting sessions. No assumption of responsibility is made, or given, and the client requesting such advice agrees not to hold Self Relativity, Inc. and/or Dr. Vahé Ohanessian responsible or liable in any form or fashion, for such actions taken of the client’s own accord. The method and process by which this advice and direction are given in no manner whatsoever, written or verbal, constitutes an agreement or liability on the part of Self Relativity, Inc. and/or Dr. Vahé Ohanessian and is acknowledged to be different in many ways than clinical and medical counselling.
The client(s) agrees that using any of these coaching and consulting services are entirely at client’s own risk especially due to the subjectivity of the concept and its understanding and/or applications. Coaching and consulting services are provided "as is", without warranty of any kind, either expressed or implied, including without limitation any warranty for information services, coaching, uninterrupted access, or products and services provided through or in connection with the service. This service is requested at the client's own choice and with inherent singular responsibility. Any actions or lack of actions, taken by the client of such advice is done so solely by choice and responsibility of the client and is neither the responsibility nor liability of Self Relativity, Inc. and/or Dr. Vahé Ohanessian.
The client takes full responsibility in the decisions they make as well as the consequences associated with the coaching and consulting services received. The client enters into coaching and consulting with full understanding that they are responsible for creating their own results. Periodically Dr. Ohanessian may provide links to other web sites or written print material which may be of value, interest and convenience to the client; however, this does not constitute endorsement of material at those sites or any such organization’s products or services. It is the responsibility of the user to make their own informed decision about the accuracy of the information at those sites and print materials including their privacy policies. In no event will Self Relativity, Inc. or Dr. Vahé Ohanessian be liable for any incident or consequential damages resulting from the use of such material.
PATIENT CONSENT TO THE USE OF REMOTE COACHING & CONSULTING
I have read and understand the information provided above regarding coaching and consulting and any and all of my questions have been answered to my satisfaction. I have read this document carefully and understand the risks and benefits related to the use of remote coaching and consulting services and have had my questions regarding the procedure explained. I hereby give my informed consent to participate in the use of remote coaching and consulting services under the terms described herein. By my signature below, I hereby state that I have read, understood, and agree to the terms of this document.