Coaching Agreement and Disclosure Statement

Thank you for your interest in working with me as a client, either in person or at a distance using the phone/Zoom/email, whichever is applicable. In my coaching practice I provide education, consultation, and support to individuals, families, groups and professionals on stress management skills, dealing with life transitions, and issues relating to preconception, pregnancy, birth, and early parenting experiences. I am providing you with the following information so you can make an informed choice about your decision to engage my services. Please read this information carefully and let me know if there is any part you do not understand. Although I will share my skills and abilities to support your well-being, my work with you is only a resource. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for and actions related to your health and well-being.

Services Offered – Theoretical Approach

In my practice I offer an approach that is considered part of the newly emerging field of energy medicine called Intuition Medicine®. Intuition Medicine is defined as a system of expanded perception of the world gained through the development of the human sense of intuition. This system, developed by Francesca McCartney, focuses on ways to increase a person’s natural intuitive abilities to assist in keeping mind, body, and spirit healthy; to increase one’s sensitivity to understanding the particular energetic nature the body is made up of; to increase personal health; and to make positive changes. As an Intuition Medicine practitioner I connect spirit-to-spirit with a client to assist the client in addressing imbalances within the client’s energy system, as well as exploring the energetic influence of thoughts, beliefs, and emotions and how they impact the client. I also incorporate the principles of prenatal and perinatal psychology that explore the importance and impact of our earliest experiences, as well as that of our later experiences attempting to conceive, during pregnancy, birth and early parenting interactions. Specifically I offer the Energetic Fertility Method™ (EFM) for women, which is a method I developed based on my studies in Intuition Medicine and my work with Walter Makichen, author of “Spirit Babies.” EFM is a multi-session process created to help women release energetic issues surrounding fertility. EFM is designed to recognize and harmonize energetic systems related to fertility in order to engender a fertile environment for conception to occur. In addition to Intuition Medicine and EFM, I also offer stress management techniques, nutritional support, and yoga. Yoga work may include mindfulness activities such as meditation, breathwork and movement/poses. If you choose to incorporate yoga, the poses are used to center, energize, relax, or calm the mind/body and are not to be used as a form of traditional exercise. If it would be helpful to incorporate any of these approaches into your coaching sessions, I would be happy to address that with you as you have the option of using individually or collectively any of the approaches I offer as part of our work together.

Although Intuition Medicine and EFM appear to have promising emotional, spiritual and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities and therefore, may be considered experimental and the extent of their effectiveness, as well as their risks and benefits, are not fully known. The practice of Intuition Medicine and EFM are self-regulated and the State of California does not license any practitioners of Intuition Medicine or EFM and considers Intuition Medicine and EFM to be alternative or complementary to the healing arts that are licensed by the State of California.

Nature of the Relationship

By signing this document you understand that I am offering my services solely as a consultant, coach and educator. While I have two (2) Masters in Psychology and have received training in prenatal and perinatal psychology, and Intuition Medicine, I’m not a psychologist, psychotherapist, physician, or other licensed health care provider nor are my services licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code, I can offer you my services, subject to the requirements and restrictions that are described fully therein.

Although Intuition Medicine uses the term medicine, it does not imply that Intuition Medicine practitioners are practicing medicine. Intuition Medicine does not “diagnose” or “treat” medical or mental-health disorders. You understand there is a distinction between “healing” using Intuition Medicine and the practice of medicine or any other licensed health care practice. As an Intuition Medicine practitioner, I’m connecting spirit-to-spirit with the client and to the energy or subtle “bodies” of the client that makes it possible to manifest a change or transformation, which is then experienced directly by the client.

Please be advised, Intuition Medicine, EFM, stress management techniques, yoga, and the application of the theoretical principles of prenatal and perinatal psychology are not intended to be a substitute for medical or psychological treatment and they do not replace the services of health care professionals. EFM is a complementary approach to traditional reproductive methods and is not intended to take the place of traditional methods of fertility enhancement. You agree to consult with your health care provider for any specific health care problems. In addition, you understand that any information shared during our sessions is not to be considered a recommendation that you stop seeing any of your health care professionals or using prescribed medication, if any, without consulting with your health care professional, even if after a session it appears and indicates that such medication or treatment is unnecessary.

For further information about my practice, including my office policies, please refer to the attached “Important Information & Office Policies” which is incorporated herein by reference and made part of this Client Agreement & Disclosure Statement. If you ever have questions or concerns about the nature of the theories and methods I use, please feel free to ask me for further resources or references.

Outcome Expectations/Risks and Benefits

While clients report positive outcomes in using my services, please note that it’s impossible to guarantee any specific results regarding your goals and we don’t know how you will personally respond to any of the approaches I offer. However, we will work together to achieve the best possible results for you. Participation in coaching sessions can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek consultation. While the approaches I use and teach are gentle and considered non-invasive, it’s possible in our sessions together or on your own between sessions to experience some physical discomfort or emotional distress that can be perceived as negative. Unresolved memories may also surface and emotional material may continue to surface after a coaching session and give indication of other issues or incidents that may need to be addressed. You agree to promptly inform me if you experience any emotional distress and/or physical discomfort during our work together, particularly between our sessions and, if appropriate, I can help refer you to an appropriate professional health care provider for further assistance. Regardless of our work together, you agree to take full responsibility for your self-care in the emotional, mental, physical, and spiritual dimensions of your life. It is important for clients, and if the client is a child/adolescent also his/her parents, to feel informed about the healing process at every level, as well as expectations and prognosis. Part of this process includes having an opportunity to ask questions and to demonstrate an understanding of what consent is being given for. This approach supports positive communication, teamwork, and improves focus of intention. It also minimizes confusion and assists energetic flow.

Education, Research, and Training

Degrees and Certificates
MA Clinical Psychology, California School of Professional Psychology, Alameda, CA
MS Cognitive Psychology, University of Washington, Seattle, WA
BA Psychology, Minor, Biology, University of California, San Diego, CA

Ordained non-denominational minister

MIM Master Certification in Intuition Medicine®, Academy of Intuition Medicine®, Sausalito, CA
Sport Psychology Certificate, John F. Kennedy University, Pleasant Hill, CA

Research and Trainings

• Individual instruction with Walter Makichen, world-renowned clairvoyant and author of Spirit Babies: How to Communicate with the Child You’re Meant to Have
• Graduate coursework at the Academy of Intuition Medicine®
  • Individual instruction with Michael McCartney, Senior Faculty Member, Academy of Intuition Medicine®
  • Heartmath Trauma Sensitive Training
• Medical Intuition coursework at Energy Medicine University
  • Workshop training with Caroline Myss & Norman Shealy
  • Workshop training with Sonia Choquette
  • Workshop training with Anodea Judith
• Workshop training with Jean Houston
• Workshop training with Dr. Sue Morter
• Workshop training with Matt Kahn
• Awakening the Illuminated Heart Workshop from Drunvalo Melchizedek’s School of Remembering
• Online Living From a Place of Surrender training with Michael Singer
• Online Healing Trauma training with Peter Levine
• Gentle & Restorative Yoga for Women’s Health training with Britt Fohrman
• Yoga Intensive (100-hour teacher training) with Kimber Simpkins
• 12-month training working with women with dual-diagnoses and their infants (both prenatal and perinatal)
• Restorative Yoga instruction with Judith Lassater
•  Dissertation Research. Unique aspects of team cohesion with female athletes. Unpublished doctoral dissertation, California School of Professional Psychology/Alliant International University, San Francisco Bay Area
• 9-month training working with elementary school students in individual and group settings
• 12-month training working with women with cancer and their families in individual and group settings
• User Experience Researcher at Microsoft, WebTV, eBay and Edward Jones. Conducted usability studies with children and adults, analyzed data, and wrote reports; conducted field studies; performed heuristic evaluations; authored and analyzed surveys; assisted with running focus groups.
• Mindfulness-Based Stress Reduction Training
• Master Thesis Research, Graduate Research, and Teaching Assistant at University of Washington. Conducted two original projects including all aspects of data collection (children and adults), coding, entry, and analysis; supervision and training of undergraduate assistants in data collection, coding, and entry. Weekly instruction of undergraduate students in Fundamentals of Psychological Research and Introductory Psychology; graded homework, examinations, and term papers; assisted with examination preparation. Does imagining healthy behaviors increase estimates of performance? Unpublished Master’s Thesis, University of Washington, Seattle, 1997. Misinformation and imagination: Active and passive modes of media presentation. Unpublished manuscript, University of Washington, Seattle
• Research Assistant at University of California, San Diego and Children’s Hospital of San Diego. Administered standardized and experimental tests; data collection, detailed language transcription, coding, and entry; data analysis; designed and implemented data coding system including documentation manual; supervised and trained employees and volunteers in data collection, transcription, coding, and entry; prepared procedures manual; redesigned computer-based experiment for children; manuscript preparation
• Undergraduate Honors Researcher & Instructional Assistant. Conducted original project including all aspects of data collection (adults), transcription, coding, entry, and analysis; write-up and oral defense. The effects of multiple eyewitness testimonies on a juror’s and jury’s ability to reconstruct the original crime. Paper presented at the 5th Annual University of California, San Diego Undergraduate Research Conference, 1992. Weekly instruction of undergraduate students in Biological Psychology and Introductory Statistics; graded homework, class participation, examinations, and term papers; examination preparation. Instructed undergraduate students on how to use Macintosh computers
• Peer Counselor at University of California, San Diego. Individual counseling for students; co-facilitated therapy group; instructed psycho-educational workshops; lectured.

Acknowledgment and Consent to Receive Services

By signing this document you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo the services I offer. You have considered all of the above information and have obtained whatever information or professional advice you deem necessary to make an informed decision. By signing this document you understand I am offering my services solely as an Intuition Medicine Practitioner and Life Transitions Coach and our relationship is not to be construed as medical treatment, psychotherapy, psychological counseling, or any type of therapy, nor is it a substitute for these services. You understand that it is your responsibility to maintain a relationship with a healthcare professional. You understand that your consent to the nature of our sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. You represent that you are competent and able to understand the nature and consequences of the proposed sessions and agree to be personally responsible for the fees related thereto. You have discussed with me the nature of the services to be provided and you understand that I’m not a licensed health care provider and that my services are not licensed by the State of California.

By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and agree to release, indemnify, hold harmless and defend Nancy Mae and her agents, representatives, consultants, and employees from and against any and all claims of whatsoever kind or nature, which you, or your representatives, may have for any loss, damage, or injury arising out of or in connection with your sessions.

In order to use my services, California state law requires that you acknowledge receipt of the information provided in this Client Agreement & Disclosure Statement. I will keep an original in my records for at least three (3) years.

IMPORTANT INFORMATION AND OFFICE POLICIES

Attachment to CLIENT AGREEMENT & DISCLOSURE STATEMENT

CONFIDENTIALITY

With the exception of special situations described below, I will keep our work together confidential. I cannot and will not tell anyone else what you have told me, or even that you are using my services without your prior written permission. You may direct me to share information with whomever you choose and you can change your mind and revoke that permission at any time.

Although I am not a licensed professional health care provider, I choose to be in alignment with general ethical standards by adhering to the following legal exceptions to confidentiality:

1. If I believe the client is in imminent danger of hurting themself
2. If I believe the client is threatening serious bodily harm to another
3. If I believe that a child, elderly or disabled person is being abused
4. If I am presented with a legitimate court order to present testimony in a legal proceeding
5. If a client fails to pay for services requiring action to collect fees due

Further, please be advised that if our sessions are being conducted over the phone or via Zoom and with email it is not possible to guarantee the confidentiality of the information contained in any of our telephone and/or electronic communications.

SESSIONS

Sessions are either one hour or two hours in length.

PAYMENT

Payment via PayPal or Stripe is expected prior to your appointment, unless previous arrangements have been made.

RESCHEDULING AN APPOINTMENT & NO SHOWS

Scheduling of appointments involves the reservation of time specifically for you. 

Please allow a minimum of 48-hours advance notice for rescheduling your appointment. If you reschedule within 48 hours of your scheduled appointment, you will be charged a $200 rescheduling fee for one-hour appointments and a $400 rescheduling fee for two-hour appointments. 

The full fee will be charged for missed appointments without such notification.

We do not offer refunds. By scheduling an appointment, you are confirming that you acknowledge that there are no refunds. If you choose to cancel your appointment, you forfeit the full fee.

SHOWING UP LATE FOR AN APPOINTMENT

If you arrive late to the call (between 1 and 15 minutes late for one-hour sessions and between 1 and 30 minutes for two-hour sessions), Nancy will work with you for the remainder of your time together. Nancy does not add additional time to the session when you arrive late. 

If you are more than 15 minutes late for a 1-hour call, then you forfeit the session.

If you are more than 30 minutes late for a 2-hour session, then you forfeit the session.

Please plan accordingly so you get the full session you signed up for. 

TERMINATION

At any time during our work together if I determine, in my sole discretion, that I cannot be of benefit to you or not effective in helping you reach your goals, I have the right to terminate this Agreement and our coach – client relationship. In such a case, upon your request, I will give you referrals that you can contact. You have the right to terminate this Agreement and our coach – client relationship at any time. If you choose to do so, I will offer to provide you with names of other qualified professionals.

CLIENT INFORMATION SHEET

In September 2003, California passed groundbreaking legislation (California Senate Bill SB-577) that has profound implications for the practice of complementary and alternative forms of health care in California. SB-577 legally enables complementary and alternative health care practitioners to provide and advertise their services to California citizens. However, they must comply with certain requirements specified within the bill that has now become part of California law under sections 2053.5 and 2053.6 of California’s Business and Professions Code.

Sections 2053.5 and 2053.6 of California’s Business and Professions Code

1. Provide access to complementary and alternative health care practitioners. You must be given information about the nature of treatment and the practitioner’s qualifications. Please ask your practitioner any question you may have about the treatment options they offer. Ask if your practitioner has been certified by a professional organization and if they belong to any professional organizations. Please tell your physician if you are receiving any alternative treatments. You can also request that your licensed and unlicensed health care providers communicate with each other and work collaboratively to meet your health goals.
2. Requires unlicensed complementary and alternative health care providers to follow certain guidelines and to refrain from certain practices.
3. Specifies that unlicensed complementary and alternative health care practitioners are NOT allowed to:

• Perform any form of surgery or any procedure that punctures your skin or harmfully invades your body
• Use X-ray radiation
• Prescribe prescription drugs, or recommend that you discontinue drugs that were prescribed by a licensed physician
• Set fractures
• Treat wounds with electrotherapy
• Put you at risk of great bodily harm, serious physical or mental illness, or death
• Imply in any way that you are a licensed physician

1. Specifies that complementary and alternative health care practitioners MUST DO the following:

• Provide you with a statement, written in plain language that includes the following information: (1) that they are not a licensed physician and that their services are not licensed by the state; (2) a brief and clear description of the kind of services they provide and the reasoning behind it; and (3) a description of their education, training, and experience.
• Ask you to sign and acknowledge that you received the above written statement, and provide you with a copy of it. They must also keep a copy of your signed acknowledgment for three years.