New START Agreement

New Start

Please complete this New Start Agreement either online or by downloading the PDF form HERE.

Information shared with Mike Asbury, CPC and all associated practice staff is deemed confidential and will not be shared with any party.  If a client wishes to allow a third party to have access to a client’s information, the client must first sign a Consent for Release of Information form.  This form may allow Mike Asbury, CPC to discuss all elements of client sessions or only specific elements, at the client’s discretion.  Consent is required in writing and may be revoked by the client at any time.

I request that the professional coach, Mike Asbury, CPC, provide professional services to me, and I agree to pay the fees for these services.  I have discussed the unique fee schedule with Mike Asbury or his agent prior to engaging services.

I agree that this relationship with Mike Asbury, CPC will continue as long as he provides services or until I inform him that I wish to end it.  I agree to pay for services provided to me up until the time I end the relationship.

I agree to communicate honestly and participate fully in the coaching process established by this relationship.

I have read this agreement and agree to act accordingly to everything stated, as evidenced by my pressing “Submit” below:

 

Comments or questions are welcome.

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