Coaching Call Application Form


Congratulations on joining The Mindful Collective. We are thrilled to have you with us! Good on you for pursuing a more compassionate and mindful life.

To help you squeeze as much as you can out of your sessions I, Amy Kate, would love to gather the following information prior to your initial sesh. This helps me make sure we are jumping in at the most helpful Stepped-Care level for you.

As part of our online coaching application we include all confidentiality and privacy information as well as other helpful questions. Some of the content may seem a little intense (or strongly worded). That is simply because, as a Psychologist, I must uphold the same ethical standards in my coaching as when I am providing Psychological Therapy. If you have concerns regarding privacy head to here for more information. 

LET’S START WITH THE BASICS

Full Name:   

Age:   

Email Address:   

Country, State and City:   

How did you initially find The Mindful Collective and what inspired you to work with us?   

What is the potential focus area you had in mind for coaching with me?  

Some of the common issues women discuss with me include:

  • Adjusting to complicated life transitions (e.g., wedding planning, relationship breakdowns, career transitions)
  • Developing effective study and time management skills
  • Building their self-awareness (including understanding and appreciating themselves)
  • Mindfully managing stress
  • Honing parenting skills 
  • Problem solving recurring issues in their lives
  • Learning how to kindly reinforce boundaries with themselves and others
  • Discussing relationship issues they’re facing, with compassion
  • Other

WHAT YOU NEED TO KNOW ABOUT OUR CONFIDENTIAL COMMUNICATION PLATFORM

Confidential online coaching gives you many, many benefits, including:

  • More access: e.g., more variety of session time available per week
  • More flexibility: e.g., you could be anywhere for your session – even at work with your office door shut
  • More convenience: e.g., while lunching, we will reflect on your past week and enhance your next
  • More consistency: e.g., you don’t need to meet a different person and tell them your story again just because you told your coach that you’re feeling particularly unsteady
  • Less inhibition: e.g., we are more likely to be more open and honest about our thoughts, emotions and experiences when we are working online with a Psychologist

We believe that it is important for you to feel safe when communicating with me online, either through instant messaging, or audio/video calls. This is why we use Sylo | Confidential Communication. Sylo is a simple website/app that was developed in New Zealand and is free for you to use. Sylo does not have a central server storing our communication content (unlike Skype) which means that our conversations are only ever shared between you and me.

With Sylo, we can:

  • Connect via high quality video and audio chat
  • Real time messaging (particularly useful for reference in future sessions)
  • Share documents, images and files without size limits
  • Connect from anywhere (well… anywhere private, we don’t want cheeky ears listening in)

Once I’ve received your completed application, I will send you a link to connect via Sylo. Then you can create your account. Before your initial consultation all you need is:

  • A tech device you can easily access the Sylo app or website (computers, phones or tablets with cameras and microphones inbuilt are ideal)
  • A power supply for that device (it happens… phones can run out of battery at the most interesting of times)
  • A safe, quiet space you are unlikely to be interrupted (hint: not an internet café)
  • A WIFI connection or plenty of data
  • A reminder on your phone to jump onto the app 5-minutes before our initial consultation start time!

WHAT YOU NEED TO KNOW ABOUT CONSENT FOR ONLINE COACHING

CONSENT FORM

Online Coaching Service   As part of providing an Online Coaching service to you, Amy Kate Isaacs from The Mindful Collective will need to collect and record personal information that is relevant to your current situation. This information will be a necessary part of the psychological assessment and Online Coaching that is conducted. You do not have to give all your personal information, but if you don’t, this may mean the service may not be able to be provided to you.

Purpose of collecting and holding information   The information gathered during Online Coaching sessions is seen only by the Psychologist. The information is retained in order to document what happens during Online Coaching sessions and enables the Psychologist to provide a relevant and informed service.

Access to Client Information   At any stage you, as a client, are entitled to access to the information about you kept on file, unless the relevant legislation provides otherwise. The Psychologist may discuss with you appropriate forms of access.

Confidentiality   All personal information gathered by the Psychologist during the provision of the Online Coaching service will remain confidential and secure except where:

  1. It is subpoenaed by a court, or
  2. Failure to disclose the information would place you or another person at serious and imminent risk; or
  3. Your prior approval has been obtained to:
    1. provide a written report to another professional or agency. e.g. a GP or a lawyer; or
    2. discuss the material with another person, e.g. a parent or employer; or
    3. if disclosure is otherwise required or authorised by law.

 

Online security   As the Online Coaching service occurs online there are more possibilities for breaches to online security. Amy Kate has a high level of security on her devices. It is highly recommended that you do as well, in order to prevent online breaches of your information. If you are unsure whether you have a high level of security a helpful resource is: www.staysmartonline.gov.au Your online safety is your responsibility. It is also important that you discuss any communication confusion with Amy Kate directly so that she can resolve the issue quickly.

Cancellation Policy If you need to cancel or postpone your appointments, please give Amy Kate at least 12 hours notice, otherwise you will forfeit that session.

I,  , have read and understood the above Online Coaching Consent Form and I believe the level of security on my devices adheres to the Australian Government’s recommendations. I agree to these conditions for the online Online Coaching service provided by Amy Kate Isaacs.

In case of emergency, my preferred contact person’s name is  , who is my  (e.g., partner, parent, sibling, housemate), and their best contact phone number is   

Please Note: If, after reading this page, you are unsure of what is written please discuss it directly with Amy Kate via phone or email prior to your first session. For more information about your privacy please ask to see our privacy information leaflet or consult the Commonwealth Privacy Commissioner www.privacy.gov.au

Charter for clients of APS psychologists

consent-form-img

Leave this empty:

The Mindful Collective https://themindfulcollective.co
Signature Certificate
Document name: Coaching Call Application Form
Unique Document ID: b4765ed599bcc6d31c72c8793077f838ef6ac0a4
Timestamp Audit
December 31, 2018 6:04 pm AESTCoaching Call Application Form Uploaded by Amy Kate Isaacs - hello@themindfulcollective.co IP 203.45.57.135