Informed Consent

I desire to work with Jake Martin and Jake Martin Coaching. 

 

I certify that I understand that Jake Martin does not claim to cure any condition, illness, or disease.  I understand that Jake Martin Coaching method is not conventional psychotherapy and is not meant to take the place of conventional psychotherapy and that it is my responsibility to seek professional evaluation and services as I need them.  If I should feel the need for help from a medical doctor or board certified/licensed professional, I understand that it is my responsibility to seek such professional assistance. I understand that Jake Martin is not a medical professional and that I am to continue all medication and any other treatment modalities that have been prescribed, unless otherwise directed by my doctor. I understand that it is my responsibility to seek medical treatment (emergency or otherwise) for any condition that could possibly warrant such treatment.  I have been informed that Jake Martin Coaching is not a currently regulated or licensed method, and I agree to take full responsibility for any ill affects, real or imagined, that I may experience from my working with Jake Martin Coaching.

 

I understand that I am financially responsible for all charges. Should I choose to

discontinue the treatment, I understand that it is my responsibility to notify Jake Martin

in writing at jakemartincoaching@gmail.com that it is my desire to do so and I agree to

pay for all outstanding charges in full.  I agree to a minimum of one session and one calibration per month charged at the current rates. If, for any reason I am not able to schedule a coaching session during the month, I agree that Jake Martin Coaching will do a second calibration to maintain consistency in the work.

 

I have read or have had read to me the above statements and have had an opportunity

to ask questions about its content.  By signing on the New Client Intake form, I agree to the terms, conditions, and procedures expressed on this page and hereby consent, authorize and request Jake Martin to administer the treatment deemed advisable and necessary to my condition in accordance with his best expertise. I agree to hold Jake Martin and Jake Martin Coaching free and harmless from any claims, suits for damages, or complications that may result from such treatment.