Session intake & agreement

For one-on-one in-person sessions using the Remove the Box method. Fill this in before your first session — it takes a few minutes and covers what the sessions are, how payment works, and how your information is handled.

1Your details

Full name

Date of birth

Mobile

Address (optional)

Emergency contact name

Emergency contact number

Their relationship to you

How did you hear about this?

2Where you're at

What do you want out of these sessions?

What's going on right now that's hardest?

Any health or mental-health background I should know about?

I'm currently seeing a doctor, psychologist, counsellor or other practitioner.

Any medication that could affect taking part? (optional)

Anything else I should know before we meet?

3Safety & scope

One-on-one sessions are coaching using the Remove the Box method. They are not therapy, counselling, psychology, medical care or any form of clinical treatment.
No diagnosis, treatment plan, prescription or clinical advice is given, and nothing said in session replaces advice from a doctor or registered health professional.
Sessions are not a crisis or emergency service. If you are in immediate danger or thinking about harming yourself, call 000, or Lifeline on 13 11 14.
You stay responsible for your own decisions, actions and wellbeing, and you agree to seek professional help where it is needed.
No specific outcome or result is promised or guaranteed.

4Payment terms

Sessions are $250 AUD each.
Payment must be made in full at least 24 hours before the appointment time. A session that is not paid in full by then may be cancelled.
Cancelling or rescheduling with more than 24 hours notice: your payment is moved to the new time or refunded in full.
Cancelling with less than 24 hours notice, or not showing up, forfeits the session fee.
Arriving late does not extend the session; it finishes at the scheduled time.
Prices may change for future bookings, never for a session already paid for.

5Privacy & consent

What you write here and what comes up in session is kept private and stored securely.
It is used only to run your sessions and is never sold or shared for marketing.
It may be disclosed without your consent only where the law requires it, or where there is a serious and imminent risk of harm to you or someone else.
Records are kept for up to 7 years and then deleted.
You can ask for a copy of your information, ask for it to be corrected, or ask for it to be deleted, at any time.

6Liability & agreement

You take part voluntarily and accept the ordinary risks of coaching work, including that discussing personal material can be uncomfortable or emotionally difficult.
To the maximum extent permitted by Australian law, Remove the Box is not liable for any indirect, consequential or incidental loss arising from the sessions, and total liability for any claim is limited to the fees you paid for the session the claim relates to.
Nothing in this agreement excludes, restricts or modifies any right or guarantee you have under the Australian Consumer Law that cannot lawfully be excluded.
You release the coach from claims arising out of decisions you make, or do not make, as a result of a session.

I have read the Safety & scope section. I understand these sessions are coaching, not therapy or medical care, and not a crisis service.

I agree to the payment terms: $250 AUD per session, paid in full at least 24 hours before the appointment, and to the cancellation and no-show terms.

I have read how my information is handled and I consent to it being collected and stored.

I have read the liability section, I take part voluntarily, and I agree to the release and limitation of liability set out above.

Optional: I'm okay with notes or recordings being kept from sessions to support my own work.

Optional: I'm okay with being contacted between sessions for follow-up.

Type your full name to sign

Signature

Sign here with your finger or mouse

Dated 26/08/2026. Submitting this form is your electronic signature on the terms above.