Begin Your Journey

STUDENT NURSE COACH & PRACTICE CLIENT AGREEMENT

This agreement is between Andrea, MSN, PHN, FNP-C (Student Nurse Coach) and the undersigned Client.

Nurse Coaching Description: Nurse coaching is a supportive, collaborative partnership focused on exploring and achieving goals that support your health, wellness, and quality of life. Your Nurse Coach helps you identify what you want to focus on, gain clarity and new perspective, and commit to action steps that move you toward your goals. This process addresses the whole person — mind, body, spirit, emotions, environment, values, and purpose.

Session Structure: You will receive 5 hours of complimentary (pro-bono) coaching. The first session is approximately 1 to 2 hours. The remaining 3 sessions are approximately 1 hour each. Sessions are conducted via phone or Zoom.

Client Obligations: As a client, you agree to: (1) attend scheduled sessions on time, (2) actively participate in the coaching process, (3) complete any agreed-upon action items between sessions, (4) provide honest feedback about your experience, and (5) notify your coach at least 24 hours in advance if you need to cancel or reschedule.

Testimonial: Upon completion of the coaching program, you may be asked to provide a written testimonial about your experience. Participation is entirely voluntary.

Recording Consent: Sessions may be recorded for educational purposes only. Recordings are kept confidential and are not shared publicly. You may opt out of recording at any time.

No Guarantee of Results: While nurse coaching supports positive change, no specific outcomes are guaranteed. Results depend on your engagement, effort, and individual circumstances.

Nature of Relationship: The nurse coaching relationship is not a therapeutic, medical, or counseling relationship. Your Nurse Coach does not diagnose, treat, or prescribe. Coaching is complementary to, not a replacement for, professional medical or mental health care.

Confidentiality: All information shared during coaching sessions is kept confidential, except as required by law (e.g., imminent danger to self or others, suspected abuse).

Release of Liability: By signing this agreement, you release Andrea and Flourishing Soulciety from any liability arising from participation in the coaching program.

Minors: If the client is under 18, a parent or guardian must co-sign this agreement.

NOTICE OF PRIVACY PRACTICES (HIPAA)

Your Information. Your Rights. Our Responsibilities.

This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

How We Use Your Information:

• Treatment: Your protected health information (PHI) may be used to provide, coordinate, or manage your coaching services.
• Operations: Your PHI may be used for quality assessment, training, and program improvement purposes.

Communication Platforms: Coaching sessions are conducted via phone or Zoom. Please be aware that while we take reasonable precautions to protect your information, communication platforms may not be fully HIPAA-compliant. By consenting below, you acknowledge this and agree to participate.

Your Rights:

• You have the right to request a copy of your records.
• You have the right to request amendments to your information.
• You have the right to revoke this authorization at any time in writing.
• You have the right to file a complaint if you believe your privacy rights have been violated.

Revocation: You may revoke this authorization at any time by providing written notice. Revocation will not affect any actions already taken based on this authorization.

Marketing: Your information will never be used for marketing purposes without your separate, explicit written consent.