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MANA Holistic Eating Disorder Recovery Coach

Client Agreement, Liability and Disclaimer




I feel privileged to be chosen as a coach to help with this transition during your journey toward eating disorder recovery.  This form provides information on various topics so please read it thoroughly.


Below you will find additional information on Eating Disorder Coaching, what is offered, and how I can help: 


CCI Certified Eating Disorder Recovery Coaches are trained to offer ongoing support and guidance for those suffering from eating disorders, focusing on the here and now and helping clients with behaviour changes necessary for recovery.


I am not a therapist, dietitian, or licensed mental health professional, I do not take the place of such, thus I cannot provide treatment or give professional advice.



Things you discuss with me in my role as your coach will be kept confidential unless I am authorized by you to share information, for example, communicating with your treatment team. I will provide you with a release to sign.


I will do my best to protect your privacy and keep all communications private. However, I cannot guarantee the privacy of electronic transmissions, such as emails, texts or even phone calls and video chats.


Working With A Coach:


A coach is trained to work with you in a unique way, outside of an office, helping you with daily living experiences. This means I will be available at times and during situations when other treatment providers are traditionally unavailable.  In conjunction with you and your treatment team, I will help establish goals and challenges for your coaching experience. I will accompany you in a variety of circumstances where your eating disorder behaviours are hard to control and together we will discover new coping strategies that I will help you utilize.


I will be available to you by text, email and phone and will discuss the scope of this kind of communication with you and if need be set up specific parameters around our communication. If at any time, I feel you are relying too heavily on text or email support, we will discuss possible solutions and find additional coping strategies you can use.


Ongoing evaluation: 


We should both be evaluating your progress and discussing the success of the coaching, our coach/client relationship and ways that we can make improvements if necessary. Ideally, we can work out any problems but you and I both have the option of terminating the relationship at any time if either of us feels there is a problem or the coaching is not a valuable worthwhile experience.


Appropriateness for Coaching: 


If I am worried about your progress or the appropriateness of continuing the coaching relationship, I will speak to you and try to work out ways to improve the situation. I might also contact your treatment team to discuss the matter (release permitting). If, at any time, I determine you are not appropriate for the coach/client relationship, due to the severity of your illness, lack of progress, inappropriate behaviour, mental condition, or other pertinent reason I will do my best to talk with you and your team (release permitting) to figure out the best next step for you.  If I perceive that you are in danger, e.g., expressing suicidal thoughts, it is my duty to immediately report this to appropriate emergency personnel. If time permits and I have a release, I will contact an appropriate member of your treatment team. If a release has not been signed, or I do not have time to communicate with your team member, I will make the best decision possible based on my training and best judgment.

Client Agreement & Liability Waiver

Please fill out the following form
in order to work with me.

Have you been hospitalized in the last 12 months?

I understand that my eating disorder coach is not a replacement for therapy or treatment. I understand that my coach is not a licensed professional and cannot provide medical, nutrition or psychological advice. It is my responsibility to use my coach as a supplement to any professional care or treatment I might need. I understand that my coach is not responsible for me or my condition or the decisions I choose to make.


By signing this agreement, I agree to comply with the coaching guidelines, participate in the coaching process and do my best to get the most out of this experience. I understand that if at any time my coach deems it inappropriate for me to continue due to my lack of progress, my behaviour, my mental state or my physical condition, I will be given referrals and will no longer continue to participate until my status changes, at which point I can request the option of working with the coach again.

Thanks for submitting!

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