Client / Facilitator

agreement & waiver

This Agreement is made as of the date below between Rick Diamond, hereinafter referred to as “Facilitator,” and “Client,” named below, for the purpose of facilitation services.

By checking the box for each provision below, Client understands and agrees to the terms of this Agreement. * indicates required fields.

I understand that the Facilitator is providing me facilitation services in a collaborative, non-judgmental, and compassionate manner. I acknowledge that the objective of the facilitation services is to help me better understand my patterns and explore various avenues of growth. *I agree to fully participate in the facilitated process, be open to self-exploration, and to take full responsibility for my own growth. *I acknowledge that the Client/Facilitator relationship is a professional one and that the Facilitator is not a licensed mental health professional. I understand that the facilitation services provided are not a substitute for medical or mental health care. *I agree to pay Facilitator upfront and in advance of all scheduled facilitation sessions. I understand that it is my responsibility to reschedule any missed appointments and that there will be no refunds for any payments made. *I understand and acknowledge that the Facilitator will maintain strict confidentiality with regard to the facilitation sessions, and all information shared within the sessions, except as required by law. The Facilitator is HIPAA compliant and will abide by HIPAA standards. *I confirm that the Facilitator has made no representations to me concerning any outcomes or guarantees relative to the work we do together in the facilitated sessions. *I, individually and on behalf of my heirs, successors, executors, and agents, hereby agree to release, discharge, hold harmless, and indemnify Rick Diamond and his respective employees, agents, and affiliates from any and all liability whatsoever for any and all damages, losses, claims, or injuries of any kind whatsoever, which arise out of, result from, occur during, or are connected in any manner to any work related to the facilitation services or this Agreement. *

I acknowledge that I have read, understood and will comply with the terms of this Agreement & Waiver. *

Client Name *

First

Last

Date *

Client Signature *

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