PC Service Agreement

Dawn Huebner, PhD

I agree to the following:

1. I understand that the purpose of Parent Coaching is to help me develop skills and implement plans to address problems I identify and describe.
2. I understand that while Dawn Huebner is a psychologist, she is not providing services in that capacity. Parent Coaching is not therapy. While therapy aims to diagnose and treat mental health problems, Coaching is designed to help me better understand my children, learn to connect and set limits in positive ways, and more effectively manage specific problems.
3. If over the course of Parent Coaching, Dawn or I believe therapy is warranted, Dawn will do her best to guide me towards appropriate resources. I understand, however, that it will ultimately be my responsibility to find a suitable therapist.
4. I understand that while Dawn will make suggestions and offer advice as part of the Parent Coaching process, I assume full responsibility for deciding which actions to take and will not hold Dawn legally responsible for any undesired outcomes.
5. I understand that if my needs are not being met, I can tell Dawn so we can refine our work or agree to bring it to an end.
6. I understand that I am responsible for the time we have scheduled, and that I must give 24 business hours’ notice to cancel or reschedule a Coaching session unless there is an emergency that makes it impossible for me to keep the appointment. Something unexpected happening at work does not constitute an emergency. I understand that I will be charged the full fee for missed appointments or appointments canceled without adequate notice.
7. I understand that Coaching will take place by phone or on an online conferencing platform. I further understand that phone and electronic communications are not secure, and that if we use these methods, my privacy is not ensured.
8. I understand that Dawn’s policy is to keep records private but that, because this is not therapy, these records are not privileged, nor is Dawn obligated to keep them for any specific amount of time. I understand that Dawn is likely to destroy my records following 12 consecutive months without an appointment.
9. I understand that payment is to be made electronically in advance of the actual appointment (before the day of the appointment). Meetings cancelled with more than 24 business hours’ notice will be refunded or credited towards the new meeting time, at my discretion. If I choose to have my payment refunded, I am responsible for all credit card and processing fees.
10. I understand the fee is $150 for a 45-minute session. Since coaching is not therapy, I know that I cannot submit a claim to my insurance company. It is up to me to determine whether I am able submit to my HSA, should I choose to do so. My partner or other adults in my child’s life can be involved in coaching sessions, at my request and with my consent, at no additional charge.