Pattern Breaking Session

Hello, Wild One! I'm glad you're here.

Please fill out this short form if you've signed up for a pattern-breaking session.

This information will give us a place to start from so we can make the most of our time together.

First name

Last name

Phone

What pattern, challenge or struggle would you most like to focus on for our session? Be as specific as possible.

What is something you desire as an outcome from working together?

Do you have any fears, questions, or concerns you would like to share with me here?

Do you have any experience with therapy, coaching, somatic work or other forms of personal work?

Have you ever been treated for a serious mental, psychological, or physical health issue? If so, please give a brief description.

Anything else you would like me to know?

Liability Waiver

As the Coach, Aspen Marino agrees to:

Stand in service to your growth and transformation.
Uphold standards of ethics and professionalism.
Be an unwavering advocate for your potential, power, and possibility.
Respond to emails, questions, and challenges within 2-3 business days when outside of designated office hours (Mon-Fri 10-4).
Communicate with you 24 hours in advance if a session needs to be rescheduled or canceled.

We both agree to:

Treat ourselves and each other with respect and compassion.
Be on time.
Trust and give space to whatever might come forward for healing.
Take full responsibility for our needs, actions, and experiences.
Stay curious

Cancellation Policy: If you need to cancel or reschedule your session, please notify me at least 24 hours in advance so there is an opportunity for someone to use that time. If less than 24 hours notice is given, you will be charged a $20 fee. No-call, no-shows will lose their session, and need to sign up for another.

Confidentiality: Everything that happens in this container is held with the utmost confidentiality. You are free to share anything from your experience in any capacity you wish, but I will keep everything to myself and share nothing from our sessions unless otherwise agreed upon by us both.

Liability Release: I understand that this work involves honesty and vulnerability. This container and its contents are not a substitute for psychiatric, medical, or any other kind of professional support that may be needed. Any boundaries or issues that arise must be addressed immediately and communicated clearly.

By signing below, I acknowledge that:

I voluntarily participate in this 1:1 session via Zoom.
I assume full responsibility for any injuries or damages that may occur during the session.
I understand that Aspen Marino will not be liable for any actions I take or do not take as a result of these sessions. No assumption of responsibility is made or given.
I take full responsibility for myself in this container.

Signature

Signature field is empty.

I look forward to meeting you!

If you have any questions, don't hesitate to reach out.