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Client Intake Form

Welcome!

I’m really glad you’re here. Making this decision is a big step, and it usually comes after a long stretch of trying to hold everything together and hoping things will feel easier.

Before our first session, please complete this intake form and review and sign the Private Coaching Agreement.

This helps me prepare for our first session so we can make the most of our time together right from the start. I’m looking forward to working with you and helping you make real, lasting change.
1.Contact Information(Required.)
2.Please provide the names of all immediate family members. Include the age(s) of your child(ren).
3.What is the biggest challenge you are currently facing regarding your teenager(s) right now?(Required.)
4.What obstacles are preventing you from resolving this challenge?
5.If I could solve one problem that would "change everything" for you as a parent, what would it be?
6.Anything else you'd like me to know?
7.How did you hear about my services?(Required.)
8.Private Coaching Agreement
Dr. Cam Consulting, LLC

This agreement outlines the terms of private coaching services provided by Dr. Cam Consulting, LLC. By enrolling in private coaching, you acknowledge that you have read and agree to the terms below.

Scope of Coaching
Private coaching supports parents in navigating challenges related to parenting teens and improving family dynamics.

Coaching focuses on understanding behavior patterns, strengthening communication, and developing practical strategies for responding to difficult situations at home.

Coaching is not therapy, medical care, or psychological treatment, and Dr. Cam does not diagnose or treat mental health conditions.

Coaching Package
Your coaching package includes:

• Six (6) private coaching sessions (90 minutes each)
• Sessions conducted virtually or in person as scheduled
• Four months of access to the Inner Circle parent mentorship community
• Access to The COLLABORATE Method Parenting Program

These resources support learning between sessions but do not expand the scope of private coaching.

Participation
Clients agree to attend scheduled sessions, participate respectfully, and remain open to exploring new perspectives and strategies.

Coaching is collaborative and results depend on client participation. Specific outcomes cannot be guaranteed.

Parents or legal guardians are the primary clients. A teen may participate in sessions when appropriate, but coaching does not constitute therapy or treatment for the teen.

Communication & Emergencies
Coaching support is provided during scheduled sessions. Communication between sessions may occur for scheduling or resource sharing but does not include emergency or crisis support.

If you or a family member is experiencing a crisis, contact 911, 988, or a licensed mental health professional.

Payment & Refund Policy
Payment must be completed in full or through an agreed payment plan prior to the start of services.

Because private coaching openings are limited, purchases are non-refundable once the first session has occurred.

Refund requests prior to the first session may be considered at the discretion of Dr. Cam Consulting, LLC.

Delivery of Services
Coaching services are considered delivered once the client receives access to schedule sessions and access included resources.

If a client chooses not to schedule or attend sessions, services are still considered available and therefore delivered. Unused sessions do not qualify for refunds.

Scheduling
Clients will receive access to an online calendar to schedule sessions.

At least 24 hours notice is required to reschedule. Sessions missed without sufficient notice will be considered used.

Session Expiration
All coaching sessions must be used within 24 months of purchase, unless otherwise agreed in writing.

Unused sessions after this period will expire.

Confidentiality & Session Notes
Information shared during sessions will remain confidential except where disclosure is required by law.

Dr. Cam may take written notes and may use secure tools, including AI-assisted note-taking technology, to generate session summaries for client reference.

Liability
Coaching is voluntary and not a substitute for professional medical or mental health care.

Clients accept responsibility for decisions and actions taken as a result of coaching discussions.

Right to Discontinue Services
Dr. Cam Consulting, LLC reserves the right to refuse or discontinue services if coaching is not an appropriate fit or respectful participation is not maintained.(Required.)