Consent Form for Parent Coaching

Parent Coaching Agreement

Please read the coaching agreement below and provide your consent by entering in your name and e-mail address, then clicking the SUBMIT button before our first coaching session.

Welcome to Affect Autism. We aim to provide you with a professional service in a comfortable, safe, friendly, and respectful environment.

Scope of Service Parent coaching will be based on the Developmental, Individual differences, Relationship-based (DIR) model of Dr. Stanley Greenspan and will be educational in nature. Coaching is not therapy and not to be considered therapy or as specific advice. DIR/Floortime coaching provided is a model of best practices and strategies that, when implemented as designed, have been found to be effective over time. You are responsible for the implementation of your own DIR/Floortime program and we cannot be held accountable for how you implement educational information that we present or the results that you achieve.

Educational Service As part of providing an educational service to you, we will need to discuss and record personal information from you that is relevant to your current situation. This information is a necessary part of your coaching.

Fees All sessions are one hour in length and are priced as single sessions or are bundled for a discount. Fees are discussed and agreed upon in advance via email. Payments are due in advance of each session.
Cancellation Policy If you need to cancel or postpone your appointment, please provide at least 24 hours notice where possible. If you do not provide 24 hours notice, rescheduling or retaining the length of the scheduled session cannot be guaranteed. If you miss more than one appointment without notice, you will be charged for the missed session, barring any unforeseen circumstances.

By filling in your Full Name and Email Address, checking all boxes, then clicking the SUBMIT button, you consent to the above coaching agreement.

By sending this email, I provide my consent to Affect Autism:

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