Informed Consent

Individual Philosophical Coaching with Danielle LaSusa PhD, LLC

Please Read Carefully:

(1) I am at least eighteen years of age, and voluntarily seek philosophical coaching from Danielle LaSusa PhD. I am free to seek her services on a continuous or intermittent basis, or to discontinue them at any time. 

(2) My identity as a client will remain confidential with regard to any research publications and/or oral presentations of the contents of our consultations. Records in this study will be kept confidential to the extent permitted by law. 

(3) If the issues we discuss include particular up-coming choices, the coach will not determine what I should or should not do, nor make any choices for me. Rather, the coach will help me to clarify the implications of my possible choices. 

(4) The following benefits are expected to result from the coaching process:
(i) Minimally, the client should gain a deeper understanding of his or her issues.
(ii) Maximally, the client should feel more empowered to cope with or to resolve said issues. 

(5) No risks are expected to result from the coaching process. 

(6) Rate: The rate is between $40 and $280 per 50-minute session, calculated at 0.1% of my gross household income, rounded up to the nearest $10. To figure out the rate: begin with your gross household income (the combined income of you and your spouse or committed partner, including all forms of income: (i.e. wages, salaries, commissions, bonuses, interest, alimony, royalties, etc.) Your gross household is "so-and-so thousand"; to calculate 0.1% this number, drop the word "thousand." (For example, "One hundred and sixty three thousand" becomes "One hundred and sixty three"). Last step: Round up to the nearest ten. ("One hundred and sixty three" becomes "One hundred and seventy"). This is your rate. 

Danielle LaSusa reserves the right to request documentation of income. 

If I prefer not to deploy the rate scale, I accept the rate of $280 per session. 

Billing/Cancellation policies:
I understand that:
(i)    Cancellations must be made at least 24 hours before the appointment start time, or else cancellation fees (amounting to half the sessions fee) will be charged.
(ii)    I will be billed monthly and will pay each month's bill within 30 days of receipt.

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Rate: The rate is between $40 and $280 per 50-minute session, calculated at 0.1% of my gross household income, rounded up to the nearest $10. To figure out the rate: begin with your gross household income (the combined income of you and your spouse or committed partner, including all forms of income: (i.e. wages, salaries, commissions, bonuses, interest, alimony, royalties, etc.) Your gross household is "so-and-so thousand"; to calculate 0.1% this number, drop the word "thousand." (For example, "One hundred and sixty three thousand" becomes "One hundred and sixty three"). Last step: Round up to the nearest ten. ("One hundred and sixty three" becomes "One hundred and seventy"). This is your rate. Danielle LaSusa reserves the right to request documentation of income. If I prefer not to deploy the rate scale, I accept the rate of $280 per session.
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By entering my full name below, I agree that I have read, understood, and hereby consent to each of the above. I have had an opportunity to ask preliminary questions about philosophical coaching in general and about Danielle LaSusa's philosophical practice in particular. All questions that I did ask were answered to my satisfaction.