Consulting Agreement Form

Scope of Services:

The Consultant agrees to provide professional consultation services related to professional licensure and regulatory matters, which may include:

• Guidance on application for licensure in one or more states

• Review and feedback on documentation for appeals or denials

• Ethics consultations and remediation planning

• Support in navigating disciplinary matters

• Preparation for communication with licensing boards

NOTE: The Consultant is not acting as legal counsel. No legal advice or attorney-client relationship is provided under this Agreement.

Payment and Terms:

Rates have been predetermined, and your agreed-upon rate will be entered below in the form box. Full payment is due at the time services are rendered. Payment must be made through PayPal electronic transfer, Zelle, or Venmo. If the Client cancels with less than 24 hours’ notice for scheduled appointments, a cancellation fee of $100 may apply.

Independent Contractor Status:

The Consultant is an independent contractor and not an employee, agent, or representative of the Client. Nothing in this Agreement shall be interpreted as creating a partnership or employment relationship.

Confidentiality:

The Consultant agrees to maintain the confidentiality of all Client information shared in the course of services except as required by law.

Disclaimers and Limitations:

• The Consultant does not guarantee any specific outcome, including approval of licensure, reversal of disciplinary actions, or acceptance of appeals.

• The Consultant does not provide legal advice, nor do these services constitute legal representation.

• The Client is encouraged to seek legal counsel when appropriate.

General Suitability of Services:

The information developed in the consultation is specific only to the client’s individual case. It cannot be generally applied as each case differs.

Governing Law:

This Agreement shall be governed by the laws of the State of Georgia, without regard to its conflict of law principles.

Entire Agreement:

This Agreement represents the entire agreement between the Parties and supersedes all prior discussions, communications, or agreements.

I look forward to working with you. Kindly, Jennifer Finch, M.A., LPC, NCC, SEP

PLEASE SIGN AND COMPLETE THE ELECTRONIC FORM BELOW TO ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE INFORMATION AND TERMS DESCRIBED HEREIN AND THAT YOU HAVE DISCUSSED WITH ME ANY PART OF THE INFORMATION YOU DO NOT UNDERSTAND.

THE ORIGINAL COPY OF THIS DOCUMENT WILL REMAIN IN MY FILE. FOR A PERSONAL COPY, YOU ARE RESPONSIBLE FOR PRINTING ON YOUR OWN.

“I FURTHER UNDERSTAND THAT CONSULTATION WITH JENNIFER FINCH DOES NOT IMPLY OR GUARANTEE THAT THE STATE WILL ISSUE MY PRACTICE LICENSE. I AM ULTIMATELY RESPONSIBLE FOR ALL ASPECTS OF OBTAINING AND MAINTAINING MY LICENSE.”