Client Agreement Form

Please take a moment and fill out the form below.















How did you hear about us? Is there someone we should thank for the referral?



Please describe the top short term and long term changes you’d like to see result from coaching.



Thank you for becoming a new client!

Now that you’re a client you’ll get special privileges like discounted maintenance sessions once you complete your initial coaching or consulting package, and other perks.

Please take a moment and be sure that you agree with the following (indicate your agreement by checking the boxes).



Agree to the following terms now that I am a client of LarinaKase & Associates:

I agree to arrive on my calls or to my meetings on time. If I am late or cancel within less than 24 hours (except in the event of an emergency), I understand that I will be billed the normal rate. I expect my coach or consultant to be on time and not to cancel except in the event of an emergency as well.

I agree to come to my sessions prepared. If I am unable to do the session work I agree to discuss and problem-solve the reason that it was difficult with my coach. Similarly, I expect my coach to come to our meeting focused and prepared.

I understand that coaching is confidential and that my coach will not disclose my personal information without my explicit consent. If my coach has networking or other opportunities for me, I will let him/her know whether it is okay to refer to me as “client.” If I provide a testimonial I understand that it will be public knowledge that I am a client. In the unlikely event that I or another party appear to be in danger, I understand that my coach will break confidentiality to ensure safety.

I agree to allow my coach to document our coaching hours towards coaching certification if she/he chooses. (No personal information will be submitted to certification review boards other than name and hours.)

I understand that upon completion of a minimum of a one-month coaching program or a half-day consultation I am eligible for a return-client reduced monthly package or hourly fee if I choose to continue with coaching.

I understand that I must use my sessions within the agreed upon time frame. In the event that an unforeseen situation arises and I need to request an extension, I will do so in writing, and understand that it may or may not be approved. Please insert agreed upon start date and time frame here:


I understand that LarinaKase & Associates has a 100% client satisfaction record. If despite my best efforts I am not satisfied with the experience or results (within 30 days of completing a program) I can request a full refund. I understand that results from coaching, especially marketing coaching, are often cumulative over time rather than immediate.

I understand that results of coaching and consulting are largely predicated on the effort and energy I put into it. I have realistic expectations about how much my coach can do for me and what I need to do. I agree to dedicate the time, energy, and commitment agreed on by me and my coach to achieve the best possible results from coaching, and to give my coach feedback about the process.

By submitting this form electronically I agree to become a client of LarinaKase & Associates and to all of the items I indicated agreement with by checking the boxes above.

Thank you and we’re looking forward to working with you!