Office Policies and Client Consent

Thanks for taking a minute to read this. These office policies are here to keep things clear and steady, so our sessions can feel focused and simple. If you want the full scope statement about what I do (and don’t do), please review the Disclaimer here: Disclaimer.

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Emergency Contact

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Contact’s Phone Number

Consent

In case of an emergency, I give Jonathan Stein permission to contact the person listed above:

I understand Jonathan is not an emergency service. This contact would only be used if there’s a serious concern about immediate safety and I cannot be reached.

48-Hour Cancellation Policy:*

I agree to the cancellation policy.

If you need to cancel, please contact me at least 48 hours in advance to avoid being billed for the session. If you cancel with less than 48 hours’ notice or miss your session without notice, you’re responsible for the full payment, since that time was reserved for you.

If you cancel late, I’ll do my best to reschedule you within the same week so you’re not charged, when possible. I can’t guarantee that.

Best way to cancel: Cancellations can be made by text or voicemail. Please don’t use email for time-sensitive changes, since I don’t check it as often.

I understand that real life happens. In cases of severe illness or true emergency, I may consider rescheduling or waiving the fee. If late cancellations become frequent, we’ll talk about what’s getting in the way and what support would actually fit.

Late Policy:*

I agree to the late policy.

If you’re running late, please let me know by text or phone. If you haven’t arrived and I haven’t heard from you by about 5 minutes after the start time, I’ll reach out once by phone or text. If I don’t hear back, I’ll wait until 15 minutes past the start time before marking it as a missed session, and billing will follow the Cancellation Policy above.

Attendance Patterns*

I understand that I am responsible for my participation.

Occasional reschedules happen. No big drama. And if we’re meeting on an ongoing basis, consistency matters. If sessions are missed frequently, I’ll bring it up so we can get honest about what’s happening.

Sometimes the issue is timing, finances, fit, or just life capacity. If it looks like our current plan isn’t working, we’ll adjust it. In rare cases, if sessions are repeatedly missed without communication, I may recommend we pause or end for now, and I may suggest other support options that fit better.

Pausing or Ending Our Work*

I understand

You can end at any time. If possible, it usually helps to have a final session to wrap up, name what was helpful, and decide what you want to carry forward. If you’d like to pause, we can also talk about what kind of rhythm (or structure) would feel more doable.

You’re welcome to return for sessions in the future if I have availability.

Payment:*

I understand that sessions are private pay.

I’m not in-network with insurance. Sessions are private pay, and payment is due before or immediately after each session. Payments are accepted through PayPal, Venmo, and credit cards.

Note*

I understand that Jonathan does not provide diagnosis codes or insurance claim forms.

Because this is coaching and not psychotherapy treatment, I don’t provide diagnosis codes, procedure codes, or insurance claim forms. If you’re seeking reimbursement, you’re welcome to check directly with your insurance company about your options.

Communication Between Sessions*

I agree to these communication boundaries.

You can text or email me for scheduling and logistics. I don’t offer crisis support by text or email, and I may not see messages quickly. If you need immediate help, please contact local emergency services or a crisis line in your area.

Online Sessions and Platform Options*

I understand and accept the privacy limits of online communication.

All sessions are currently held online. We can meet using platforms like Zoom, FaceTime, WhatsApp, Doxy, or by phone, depending on what we agree on.

I take your privacy seriously, and it’s also true that no online platform can be guaranteed risk-free. By choosing to meet online, you acknowledge and accept the ordinary privacy limits of internet-based communication, and you’re free to choose the option that feels best to you.

Privacy and Confidentiality*

I understand how confidentiality works in coaching.

What you share with me is treated as private and handled with care. I don’t share your information without your written permission, except in rare situations where disclosure may be required by law, or where there is a serious concern about immediate safety.

It’s also helpful to know that coaching confidentiality may not carry the same legal protections as psychotherapy in every situation. If you have questions about privacy, we can talk them through before we begin.

Scope of Practice*

I understand the scope of Jonathan’s work.

I understand that Jonathan Stein is a Holistic Mind and Life Coach. He is not a state-licensed medical or mental health provider. He does not diagnose mental disorders, prescribe medication, or provide psychotherapy treatment.

Our sessions are meant to support practical growth, steadier self-understanding, and real-life integration. If I need medical care, psychiatric care, or licensed mental health treatment, I will seek that support from a licensed provider.

(For the full scope statement, I can review the Disclaimer.)

Good Fit and Referrals*

I understand that Jonathan may refer out if I need a different kind of care.

If it becomes clear that I need support outside the scope of coaching, we’ll talk about that directly. When appropriate, Jonathan may recommend that I also work with, or transition to, a licensed clinician or other qualified professional.

(If applicable) Minor Sessions

I authorize a session with my child or dependent.

I confirm that I am the parent or legal guardian and I consent to Jonathan meeting with my child or dependent. I understand that these same office policies apply.

Note: If you have questions or concerns about anything in this form, please reach out. By signing below, I state that I have read, understand, and agree with the terms defined on this form.

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I welcome and affirm people of all body sizes, abilities, races, ethnicities, sexualities, genders, religions, and political values. I’m committed to creating a space of respect and care for everyone.

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Phone

1-413-296-2861

Address

Jonathan Stein
Holistic Mind & Life Coach

All sessions are currently conducted online via secure video.

Based in Northampton, MA

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