Disclaimer Signature Form

quality for life coaching

linzi levinson, M.A. ~ Doctoral Candidate, Ph.D. Organizational Psychology

Life, Relationship & Executive Coach ● Mediator & Conflict-Resolution Specialist ● Sexuality & Intimacy Educator

Please note that while there may be terminology that appears on forms or materials and even enters into discussions that includes the word(s) "psychotherapy". "therapist", "therapy", "mental health professional"; please understand clearly that for the purpose of the relationship with Linzi Levinson in connection to any business services received from Linzi Levinson through this Life Coaching practice, I, Linzi Levinson, am claiming to be working only in the capacity of a Life Coach. While therapeutic issues may be come up or be discussed in sessions; if you feel you are in need of true clinical psychotherapy, or feel you are at risk for mental health issues that are compromising your health, safety and wellness, please seek a therapist immediately. I would be glad to assist you with referrals to accomodate and meet your needs should this need arise, and truly hope that you would allow me to do so.

During Life Coaching, issues regarding business matters, legal matters, family matters, health matters, financial matters and other matters may be part of the discussions, but please understand that I, Linzi Levinson, in no way am working in the capacity of anything other than a Life Coach. So while you may trust guidance from the coaching with regard to these subject matters, should you need expertise, or feel that any decisions need critical attention, please seek the guidance / counsel from the expert in the specific field of which your those needs require.

This form is a disclaimer in that I, Linzi Levinson, am acting only as a Life Coach and upon signing it, you are agreeing to hold me harmless as to having represented myself in any of the capacities or positions listed above as well as acknowledging that i have made it clear i am not treating you in any of the advisory positions listed above.

Client Name:______________________________________________________Date:_________________________________

Life Coach:________________________________________________________Date:_________________________________