Lisa M Stephen, Ph.D. Peak Performance Coach CONSENT FOR INTRODUCTORY COACHING CONVERSATION FOR MINORS My signature below documents my permission for my child to participate in a brief discussion with Dr. Stephen to learn about peak performance coaching and the specific services she offers. If my child meets with Dr. Stephen online or by phone, I will ensure they have a confidential space during the meeting. I understand that this is an introductory conversation and that there will be no coaching assessment or services provided. I also understand that coaching does not include any mental health assessment or treatment.Parent/Guardian Name*Date* Date Format: MM slash DD slash YYYY Parent/Guardian Signature*My signature below documents that I would like to speak with Dr. Stephen about my performance goals and the struggles I am experiencing in achieving those goals. I would like to learn about how peak performance coaching and other resources might be helpful to me in achieving my goals.Athlete/Performer Name*Date* Date Format: MM slash DD slash YYYY Athlete/Performer Signature* 89 Rye Circle #1, South Burlington, VT 05403 • drstephen@ignitepeakperformance.com • 802-355-9299 • www.ignitepeakperformance.com BUILDING THE MINDS OF CHAMPIONSEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
