Client Agreement Intake Form (copy)
Below is a copy of the Client Agreement Intake Form to be completed prior to booking a session.
This is part of the booking process. By ticking the boxes at the time of completion, you agree to the terms and acknowledge this as your electronic signature.
NB: Please click on ‘SIGN UP’ in the top right hand corner of the bookings page to create an account to save your details and save time booking in future.
NEW CLIENTS: Thank you for taking the time to complete this form. It is detailed to ensure clarity and alignment in our work together, and to support a safe, personalised experience.
RETURNING CLIENTS: Thank you for reviewing this document regularly.
Click on SIGN UP in the top right hand corner of this booking page to create an account to save your details and save time booking in future.
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This agreement is between YOU ("the client") and Lisa Barnard, trading as Butterfly Effect with Lisa.
EFFECTIVE DATE: is automatically captured by the form date or the date of you completing this online form - whichever is the latter.
1. CONSENT, PRIVACY & ELECTRONIC AGREEMENT
1a. Please take your time to read each section carefully and check the relevant tick boxes provided to confirm your understanding, and consent. By checking the relevant tick boxes, you acknowledge that this action constitutes your informed consent and agreement and is intended to serve as your electronic signature for the purposes of this agreement. If anything feels unclear, feel free to ask before submitting.
1b. Please ensure your details remain current by checking them regularly and updating them if anything changes, so I can ensure you receive any important updates, including changes to this agreement or related policies.
1c. This helps ensure our sessions together are personalised, transparent and aligned. All personal information shared here is confidential and stored securely in line with Australian Privacy Principles (APPs), Queensland regulations, and international privacy laws and GDPR standards. Your details will be exclusively for coaching related purposes - you can find more at https://www.be-withlisa.com.au/legal
2. OUR WORK TOGETHER:
2a. MY BACKGROUND & PROFESSIONAL BOUNDARIES
I bring years of experience working with families, young people, educators, and leaders through a unique combination of:
- Coaching and NLP practices
- Energetic awareness & metaphysical insight
- Grounded mentoring and facilitation
- A career background in teaching and communication
I am committed to professional supervision, training, and reflection so I can bring the best of what I know into collaborating with you.
Coaching is a professional, non-therapeutic partnership. Coaching is NOT therapy, counselling, or medical advice.
I am a certified professional coach, and former primary school teacher. However, coaching is not educational tutoring or psychological counselling. Educational support, medical advice, or diagnostic services are not provided.
I am here to support you - your growth, self-awareness, direction, communication, and well-being. This is a forward-focused, partnership where I hold space, ask questions, offer insights, and support you in making aligned choices.
Sessions may include reflection and/or reflective tools, discussion, visualisation, intuitive guidance, or other practical exercises, depending on your needs.
2b. AS A CLIENT YOU AGREE TO:
- Communicate openly and honestly.
- Attend sessions on time and as agreed.
- Set meaningful goals and take actions towards them.
- Respect the coaching process and give it your full commitment.
2c. YOU UNDERSTAND:
- You are responsible for your own decisions, actions, and outcomes.
- You are responsible for your own physical, mental, and emotional well-being choices and actions
- Coaching does not replace professional advice (medical, psychological, financial, legal, or otherwise).
- If you are currently under the care of a mental health or medical professional, you agree to inform them of your participation in coaching if appropriate.
- You will be engaging with tools such as reflective questioning, energy awareness, goal setting, and values-based alignment amongst others.
- I trust you to honour your own boundaries and needs as we work together.
3. AS YOUR COACH I AGREE TO:
- Manage sessions effectively and professionally.
- Maintain confidentiality, except where legally required or to prevent harm.
- Adhere to the International Coaching Federation (ICF) Code of Ethics: www.coachfederation.org/ethics.
- Engage in professional supervision and development.
3a. COMMUNICATION & EXPECTATIONS:
I will be honest, compassionate, and focused in our sessions – asking powerful questions, offering insights, and holding you to your intentions. If something does not feel aligned, you are encouraged to let me know. I am here for a co-creative relationship that supports your highest good.
4. RELEASE OF INFORMATION FOR CERTIFICATION (Optional)
- As part of professional accreditation, I may be required to provide limited details (your name, contact email, and start/end date of coaching) to verify my experience with the ICF.
5. SUPPORT BETWEEN SESSIONS:
You are welcome to message me between sessions via email, text, or Instagram for updates or short check-ins.
- Responses will be within 1-2 business days.
- Calls requiring longer than 10 minutes of support, will be invited to book a full session.
6. PAYMENT, CANCELLATIONS & RESCHEDULING
PAYMENT:
- Sessions must be paid in advance unless otherwise arranged.
- Packages must be paid upfront and must be used within the agreed period (the same rescheduling policies apply – see below).
- Additional time: $20 per 10-minute increments (maximum 30 extra minutes).
CANCELLATION OR RESCHEDULING:
- Sessions can be cancelled or rescheduled, up to 24 hours before your session, via the confirmation email.
- Cancellation or rescheduling, up to 4 hours' notice prior, will incur a $50 admin fee.
- Missed sessions without notice or sessions cancelled less than 4 hours' prior are charged in full.
- You can reschedule up to three times; After that, we will check in about whether the timing still works for you.
-If you are more than 15 minutes late, your session will be cancelled by text and charged in full.
7. ENDING THE COACHING RELATIONSHIP
- You are free to end the coaching relationship at any time. I simply ask for open communication and 30 days’ notice if we have entered an ongoing container.
- Unused, pre-paid sessions will be refunded, minus any late cancellation fees where applicable.
- Any unresolved concerns can be brought to me (Lisa) directly for open discussion.
8. DISPUTE RESOLUTION
In the event of a dispute:
- Both parties agree to attempt resolution via mediation, within 30 days, before taking legal action.
- If unresolved, legal action may be pursued, and any damages will be limited to the total fees paid by the client for services delivered. The prevailing party may recover reasonable legal fees.
9. PRIVACY, CONSENT & CONFIDENTIALITY, and GDPR (General Data Protection Regulation)
Your privacy matters deeply. What you share in our sessions stays between us, unless:
- I am legally required by law to report something (e.g., risk of harm to yourself or others, child protection)
- You give me written consent to share something (e.g., with a health professional or support person).
- It is for my own professional supervision, accreditation, or learning purposes, in which case details will be used anonymously unless you consent otherwise.
- All personal information is stored securely and kept confidential and you may request access to your information at any time or ask for it to be deleted in accordance with privacy laws.
10. ACKNOWLEDGEMENT & AGREEMENT
By checking the box below, you confirm that:
- You have read, understood and agree to the terms and conditions above.
- You are over 18 years old or have consent from a parent/guardian.
10a. IF UNDER 18 YEARS OF AGE
If the client is under 18 years of age, a parent or legal guardian must provide consent for engaging in coaching sessions with Lisa Barnard.
FINAL CONSENT:
Please check the relevant tick boxes below to confirm your understanding, and consent for each category.
REMEMBER: By checking the relevant tick boxes, you acknowledge that this action constitutes your informed consent and agreement and is intended to serve as your electronic signature for the purposes of this agreement.
If anything feels unclear, feel free to ask before submitting.
Thank you for taking the time to complete this – I look forward to co-creating together.
Lisa Barnard
BE with Lisa | Butterfly Effect with Lisa