Congratulations for taking a big step towards creating a more contented and fulfilling future. I’m so happy that you are here! The information that is gathered, both written and during the initial intake session, assist me in developing a basic understanding of your personal history and learning more about your current supports and stressors. The information that you share allows me to do a better job of meeting you exactly where you are and helps me to tailor your program to best meet your individual needs.
Everything that you disclose on this form and and in the pre-program assessment is securely stored, never used for any purpose other than those discussed above. Please answer as completely and candidly as possible, but feel free to leave areas blank if you are uncomfortable or prefer to discuss the issue in a follow-up phone call.
The purpose of my work is to assist people in making changes in their lives through education and supportive guidance. The information I offer in this program is based on my lived experiences, as well as, evidence-based practices and information I learned while working as a researcher and earning my PhD in the field of psychology and behavioral change. By participating in my coaching services, consulting sessions, mindset and positive change curriculum, and/or reading course manual, guidelines, handouts, e-books or email series, you acknowledge that I am not a licensed psychologist or medical doctor and my services do not replace the care of psychologists, doctors, or other healthcare professionals. Coaching is in no way to be substituted for psychological counseling, psychotherapy, mental health counseling, or any other type of psychotherapy or medical advice.
Additionally, any services, trainings, and other materials offered through me (Hodge Consulting LLC) have the potential to stir emotional or physical responses and/or stress. The objective of the services and offerings are psycho-educational, not psychotherapeutic in nature. Please consider enlisting the support of a psychotherapist or clinician who can be another resource to you both during and after the course. Hodge Consulting LLC is not liable for any distress participation might create.
Please check the box below to indicate that you have read the disclosure above and are in agreement with participating in services.
