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Empowerment Oasis, PLLC

Counseling Beyond the Norm

Established April 13, 2020

(336) 423-8775

Empowerment Oasis, PLLC

Intake Packet

Dear Client,


Welcome to Empowerment Oasis, PLLC. I am so excited to be working with you in this process. Coaching is all about you getting where you want to be through personal exploration, goal setting, and action steps. It is my pleasure to be of assistance, but please know that I view you as the expert on you.


This process is about you leading the way by defining your own goals, developing your own definition of success, and helping me to support you on this journey.


Clients have the best results when they are honest with themselves throughout the coaching process. Communication is key! It is important that we agree to welcome new ideas and be accountable to agreements established. I will do my best to be straightforward and supportive and will work to build trust so we can develop the most effective and rewarding coaching experience for you.


Again, I am so happy to be working with you and I very much look forward to our first session. Please call with any questions.


Wanda Kellyman, M.Ed., M.S, BCC

Empowerment Oasis, PLLC

Coaching Agreement

Coaching is a collaborative process with an ongoing relationship between the Client and the Coach. The coaching experience supports the Client in establishing new behaviors. The coaching relationship is strengths-based, forward-looking, and challenging in an encouraging way. The coaching agenda is developed and implemented in partnership between the Client and Coach. The role of the Coach is to help the Client in a supportive and respectful way to progress toward achieving a goal(s).


The Client and Coach agree to engage fully in the coaching experience. The Client recognizes that coaching is not to be construed as psychological counseling, psychotherapy, consulting, or any health-related service. It is the Client’s responsibility to seek a licensed professional if the Client feels the need for professional counseling or therapy.

Confidentiality

Coach agrees to keep all conversations and information with the client private and confidential, as allowable by law.


No personal information will be shared with anyone, directly or indirectly, without the Client’s express permission. Exceptions may be made if there is an imminent threat of serious injury to oneself or someone else. In this case, I will inform potential victims and legal authorities so that protective measures can be taken. In addition, under the court subpoena, our confidentiality agreement is not protected by law. Should it ever happen, I cannot claim in court to be unable to divulge the contents of our conversations.

Coaching Commitment

Coaching results are not guaranteed. You enter coaching with the understanding that you are responsible for creating your own results. You are hiring Wanda Kellyman, M.Ed., MS for the purpose of advising and supporting you with respect to achieving your goals. By entering into this relationship, the Client and Coach acknowledge that the Client desires to make a change or some type of improvement in his or her life.


The first session will be a time for us to go over coaching and it will be a visioning session, so please hold 1.5 hours of your time for that session. All future sessions will last approximately 45 minutes. I am attaching a series of questions for you to complete as well. Please send those back to me 24 hours before our session. You will notice that the last page is a form to be completed before the following session as a way for you to guide the conversation. Again, the more honest and thoughtful you can be, the better the outcome.


Payment is due before the first session. The fee for this coaching process, which includes a visioning session and three coaching sessions and any correspondence in between, is $350. Acceptable payments are by cash or credit/debit card only. 

Coaching Session Procedures

  • Coaching sessions may occur in person or through video conference, depending on what works best for the Client.
  • The Coach and Client agree to adhere to established appointment times.
  • The Coach and Client agree to begin and finish all appointments on time. If the Client is more than 15 minutes late to an appointment, the Coach will assume that the appointment is canceled, and the Client will be responsible for the full coaching fee. If the Coach is more than 15 minutes late to an appointment, the Client may assume that the session is canceled, and the Client shall not be responsible for any payment for that session.
  • The Client agrees to cancel or reschedule an appointment at least 24 hours in advance, without a charge fee of $35 sent one week after. 

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Only select goals which you truly want. Look deep inside and then write 3-5 of your personal and/or professional goals. When you set the right goals for yourself, you will probably feel excited, a little nervous, and willing to get started. Your goals may evolve over time. This exercise is to give you a clear place from which to start.
What gifts do you have? Evaluate your strengths and list the top five below.
What are you most pleased and proud of having accomplished?
1.) If there were no obstacles in the way, what dream would you like to make happen? 2.) Think about one or two people you know who inspire you. What about them is inspiring? 3.) What parts of your current job or life activities do you enjoy the most? 4.) What two steps could you take immediately that would make the biggest difference in your current situation? 5.) How have you been motivated in the past to reach difficult goals, make difficult decisions, or do challenging things? How can we best utilize that motivator now? 6.) Do you give your power away? When, and to whom? 7.) What do I need to know about you that will help me most in coaching you?
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