Scope of Practice

What We Are & What We Are Not

Breathing 4A Reason LLC offers faith-centered encouragement, life coaching, and peer support, held entirely online. Please read this honest description of what our work together is and is not.

What We Are

A safe, compassionate space to be seen, heard, and encouraged
Virtual life coaching & peer support for growth and hope
Faith-centered reflection, offered when you want it
Accountability, encouragement, and community

What We Are Not

Not psychotherapy, counseling, or mental-health treatment
Not medical, psychiatric, or clinical care
Not a substitute for a licensed therapist or doctor
Not a crisis, emergency, or suicide-prevention service

Immediate Help — 24/7

988 — Suicide & Crisis Lifeline (call/text) · 911 — emergencies · Text HOME to 741741

I have read and understand “What We Are & What We Are Not,” and that these services are not a replacement for professional medical or mental-health care.

Agreement to Services

Informed Consent & Service Agreement

Voluntary Participation

Participation is entirely voluntary. You may ask questions, decline any topic, pause, or end services at any time.

Sessions, Scheduling & Payment

All sessions are held virtually (online). A private video link is sent after you book — please join from a quiet, private space.
Payment is due at booking; course tuition is paid securely online.
Cancellations: please give at least 24 hours’ notice when possible. Late cancellations may be charged.
Sliding-scale options are available — no one is turned away for cost.

Assumption of Risk & Release

Reflective conversation may bring up strong emotions. You participate at your own discretion and assume responsibility for your own well-being. To the fullest extent permitted by law, you release and hold harmless Breathing 4A Reason LLC, its owner, and representatives from claims arising from participation, except for gross negligence or willful misconduct.

No Guarantee & Governing Law

No specific result or outcome is promised. This agreement is governed by the laws of the State of Georgia (Breathing 4A Reason LLC, GA Control No. 26121342).

I have read and consent to receive virtual coaching and peer-support services. I understand these services are not therapy, medical, or crisis care. I understand the cancellation, payment, and liability terms.

Tell Us About You

Client Intake

There are no wrong answers — share only what you’re ready to.

Your Information

Full Name

Preferred Name / Pronouns

Phone

Email

How did you hear about us?

Emergency Contact

Name

Relationship

Phone

Your Heart Today

How’s your heart today? What brings you to this space?

What would you like support, encouragement, or accountability around?

What made you smile recently?

What does “thriving” look like for you?

Anything we should be mindful of so this space feels safe? (optional)

I’d like faith-centered reflection (prayer, scripture) included when appropriate.

Your Privacy

Confidentiality & Privacy Notice

What you share is kept private and confidential, and is never sold or shared for marketing.

How we protect your information

Your information and our conversations are kept confidential.
Notes are stored securely and accessed only as needed to serve you.
We never sell, rent, or trade your information.

Limits of confidentiality

We may be required to share information, even without permission, if:

There is a risk of serious harm to yourself or another person.
We suspect abuse or neglect of a child, elder, or vulnerable adult.
Required by a valid court order or by law.

Because coaching and peer support are not licensed health care, communications are not protected by therapist–client privilege or HIPAA. In any group setting, what’s shared in the group stays in the group.

I have read and understand how my information is protected and the limits of confidentiality.

Optional Permission

Media & Testimonial Release

This is entirely optional — your services are never affected by your choice.

I give Breathing 4A Reason LLC permission to:

Use a written testimonial or quote I provide, on the website and social media. Display my first name with my testimonial (otherwise anonymous / initials only). Use photographs or video in which I appear, for promotional purposes. I prefer not to share any testimonial, photo, or video at this time.

If you’d like to share a few words (optional)

7-Week Course (if enrolling)

Course Enrollment — Live to Be Alive

Complete this step only if you’re joining the 7-week course. Otherwise, simply continue.

Cohort / Start Date

Done a free Discovery call?

Tuition is $497, held entirely online and paid securely.

I have paid the $497 tuition via the secure online checkout (PayPal / card). I’m requesting a sliding-scale arrangement (we’ll be in touch).

Refund Policy

Before the course begins: full refund if you withdraw at least 48 hours before your start date.
First-week grace window: refund before Week 2 begins, less a $50 admin fee.
After Week 2 begins: tuition is non-refundable (materials & your place are reserved).

I will honor other participants’ privacy — what’s shared in the group stays in the group. I have read and accept the Refund Policy above.

What are you hoping to find, release, or build over these 7 weeks? (optional)

Your Agreement

Acknowledgment & Signature

By signing below, I confirm I have read, understood, and agree to the forms in this set.

I understand Breathing 4A Reason LLC provides faith-centered virtual coaching, encouragement, and peer support, which is not therapy, medical care, or crisis services. I participate voluntarily and take responsibility for my own well-being. In a crisis I will contact 988 or 911.

Typing your name acts as your electronic signature.

Client Full Name (e-signature)

Date

Parent / Guardian (if under 18)