Health Coaching

A Holistic Approach to Healthy Lifestyles

A certified Health Coach is a wellness authority who educates, motivates, and supports individuals to cultivate positive health choices necessary to live the life you always imagined through lifestyle and behavior adjustments. As more and more awareness is given to preventative care, health coaching is seen as a vital aspect of creating healthy lifestyle changes. Health Coaches are essential and integral parts of people’s health and well-being. Schedule an appointment, what are you waiting for?

To schedule a Health Coaching session, please complete the Life Coaching Intake Form below. You will receive a request to create a client portal account to request an appointment. The initial one-hour session is $200.00 and is payable by debit or credit card.

Coaching is not covered by health insurance or EAP. Please complete the counseling intake form on the home page if you want mental health counseling. Please acknowledge you are aware Coaching is an out of pocket expense. *

I understand Coaching is not counseling and not covered by insurance/EAP.

Name *

First

Last

Date of Birth (mm/dd/yyyy) *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Upload Drivers License or Military ID (front) *

Click or drag a file to this area to upload.

Upload Drivers License or Military ID (back) *

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What motivated you to pursue Life Coaching at this time?: What would you like to be different about your life? *

Do you have a history of mental health or substance abuse treatment? *

Yes, I am currently working with a therapist or psychiatrist
Yes, I have a history of mental health or substance use treatment and successfully discharged from treatment for more than one year
No

Requested Coaching (check all that apply) *

Life Coaching
Health Coaching
Executive/Leadership Coaching
Christian faith incorporated into the coaching session

Signature to Consent To Coaching *

Coaching is a collaborative process that is present and future-oriented. It is action-oriented, solution-focused, and encourages change. It involves accountability and commitment to growth through increased competence, commitment, and confidence. As the client, you set the agenda for these sessions and your success will largely depend upon your willingness to define goals and try new approaches. You can expect me, as your life coach, to be hopeful, encouraging, honest, ask thought-provoking questions, offering challenging techniques to help you keep moving forward. Life coaching is not currently a regulated industry in the state of Virginia. Kimberly Best Johnson has certification from Integrative Nutrition as a Health Coach that incorporates all aspects of wellness, mind, body, Spirit, relationships, and career. It will be solely the responsibility of the client to determine the effectiveness of the services rendered and the competency of the coach. Life coaching is not psychotherapy or counseling. Life coaching does not address or diagnose mental disorders as defined by the American Psychiatric Association. Your life coaching sessions are not a substitute for counseling, psychotherapy, mental health care, or substance abuse treatment. Psychotherapy is a healthcare service and its primary focus is to identify, diagnose, and treat nervous and mental disorders.* Confidentiality: While we are not bound by the laws of HIPPA, confidentiality is an important element of the coaching process. Your identity and ongoing work will be kept strictly confidential. I will only release information about our work with your written permission, or if I am required by court order. The following exceptions apply 1. There is a broad range of events that are reportable under child protection statutes. Physical or sexual abuse of a child will be reported to Child Protective Services. When the victim of child abuse is over age 18, I am not legally mandated to report it unless I believe that there are minors still living with the abuser who may be in danger of being abused. Elder abuse is also required to be reported to the appropriate authorities. 2. If you are at imminent risk to yourself or someone else or make threats of imminent violence against another person, I will take appropriate action. 3. Visions staff may have access to your confidential data. Every staff member is held to the same strict confidentiality practices. Occasionally we may need to consult with other professionals in their areas of expertise to provide the best treatment for you. Information about you may be shared in this context without using your name. 4. If we see each other accidentally outside of the coaching office, we will not acknowledge you first nor should you feel obligated to acknowledge us. Your right to privacy and confidentiality is of the utmost importance, and we do not wish to jeopardize your privacy. However, if you acknowledge us first, we will be more than happy to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the coaching office.* No Third-Party/Insurance Payment Policy: Ultimately financially responsible for any balance. Visions does not bill to any third-party payers nor do we provide any information other than receipts of payment made by you to you should you decide to seek reimbursement for our services. * Fees and Payment/Cancellation Policy: Payment is due at the time services are rendered. Our team members’ fees per hour of coaching services range from $180.00 to $200.00 Because we operate “By Appointment Only”, cancellations with less than 24 hours’ notice will result in a fee equal to the total amount of the missed session debited from your credit card. After the first no-shows/late cancellations, the client will pre-pay before services are rendered. Clients who have pre-paid agree to have the entire hourly fee deducted from their pre-payment in cases of no-shows and late cancellations. Other services include emergency phone calls over 15 minutes, generating reports, consulting with other agencies and professionals at your request, and the time spent performing any other services you may request. These services will be charged as they occur. PLEASE NOTE: By scheduling a session at Visions, you have agreed to have your credit card on file for the coaching sessions. Any credit card disputes will result in Visions producing a copy of this signed agreement to the company notifying us of the “chargeback” in order to recover our fees. Any additional “chargeback” fees will also be assessed to you the client. Acknowledgment and Release of Liability: By signing indicate you have read and understood this disclosure and consent statement, I acknowledge that I understand the above information. I agree to hold harmless Visions and my life coach from all liabilities and claims which may arise as a result of my participation in life coaching.*

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