Client Confidentiality Agreement

Mediation of the Self

Effective Date: ___________________

1. Purpose
This Confidentiality Agreement is designed to protect the personal information, reflections, and communications shared by clients participating in peace coaching, self-awareness, and spiritual support services provided by Mediation of the Self.

2. Confidential Information
Confidential information includes, but is not limited to:
- Client intake forms and assessments
- Coaching session notes and reflections
- Journals, worksheets, and written submissions
- Personal stories, beliefs, and experiences shared verbally or in writing
- Contact information and scheduling records

3. Use of Information
Client information is used solely for:
- Providing peace coaching and self-awareness services
- Supporting client growth and understanding
- Maintaining internal records for continuity and accountability

4. Information Protection
Mediation of the Self commits to safeguarding client information by:
- Using secure, password-protected digital storage
- Limiting access to authorized personnel only
- Avoiding public or unsecured sharing of personal data
- Maintaining reasonable backup systems to prevent data loss

5. Limits of Confidentiality
Confidentiality may be limited in the following situations:
- If disclosure is required by law or court order
- If there is a reasonable belief of risk of harm to the client or others
- If necessary to prevent illegal activity

6. Non-Therapeutic Services Disclaimer
Mediation of the Self provides peace coaching and self-awareness services. These services are not a substitute for licensed medical, mental health, or legal care. Clients are encouraged to seek professional help when appropriate.

7. Client Consent
By participating in services, the client acknowledges and agrees to the terms of this Confidentiality Agreement.

Client Name: ______________________________
Signature: ________________________________
Date: ___________________