INTAKE FORM

 
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Name
Primary Phone *
Primary Phone
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AGREEMENT TO TERMS AND CONDITIONS AT BOTTOM OF THIS PAGE *
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Terms And Conditions

To complete your registration, you must agree to the following Terms and Policies. By completing the form above, you consent to all of the following conditions:

    1    The information provided through scheduled coaching calls or other programs offered by the Coach is not intended to be, nor is it implied to be, a substitute for professional, medical, psychiatric, therapeutic, or pharmaceutical advice. The Client should always seek the advice of their physician or other qualified health care provider prior to commencing any treatment for any conditions, diseases or maladies, and questions in relation to such treatment should be directed to such professional health care providers. The Client should never disregard their professional medical advice or delay in seeking such advice because of information obtained from the Coach.

    2    Coaching calls are sixty (60) minutes in length. Coaching calls are held by telephone, Skype, or using the Coach’s private conference line. (To be decided by the Coach.) Call-in details will be provided to the Client upon registration.

    3    Coaching calls may be recorded for the Client’s personal use only. All information disclosed to the Coach is confidential and will not be revealed to anyone without the Client’s written permission.

    4    Coaching call(s) are non-refundable or transferable. Coaching call(s) with the Coach must be used by the Client within six (6) months of the purchase date.

    5    All appointments require a minimum of 24-hours-notice for rescheduling or cancellation. Cancellation outside of the 24-hour time zone will not be refunded. Consistency is important to the efficacy of coaching, so please try to reschedule within the same week.

    6    The Client shall indemnify and hold the Coach harmless from any loss or liability arising from actions taken or situations created as a result of the coaching relationship.

    7    The Coach and Client will not be under the influence of alcohol, illegal drugs, or prescribed drugs used without the authority of a physician while participating in coaching sessions. This does not include drugs prescribed by a physician or over-the-counter medications used according to the directions label.

Please Note: By completing and submitting this form, you acknowledge that you understand

and accept our Terms and Policies as outlined above.