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Individual Therapy
Relationship Coaching
Wellness Courses
Pricing
New Client Financial Agreement
Name
*
First Name
Last Name
Rates
*
Individual Coaching = $149
Credit/Debit Card Number
*
Expiration Month
*
01-January
02-February
03-March
04-April
05-May
06-June
07-July
08-August
09-September
10-October
11-November
12-December
Expiration Year
*
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
CVC
*
Credit/Debit Card Billing Zip Code
*
Fees
*
I, the client, understand and accept the following: 1. Individual Coaching @ $149 x 50 minute session (in-person/online) 2. There is a service fee of $3 for each coaching session 3. Payment must be made in advance of all scheduled coaching sessions. 4. Payment must be made online using a credit or debit card.
I confirm that I have read, understood and agree with the above.
Cancelation and Rescheduling
*
I, the client, understand and accept that… 1. If I need to reschedule/cancel a coaching session, I must provide at least 24-hours’ notice. 2. If I fail to provide at least 24-hours’ notice, I will be charged the full session fee.
I confirm that I have read, understood and agree with the above.
Refund Policy
*
I, the client, understand and accept that… 1. There are no refunds once services have been rendered.
I confirm that I have read, understood and agree with the above.
Terms
*
As a coaching client, I understand and agree that I am completely responsible for my well-being during my time in coaching. This includes my choices and decisions. No guarantees have been made to me as to the expected outcome of my coaching. I am aware that I can choose to discontinue coaching at any time. I recognize that coaching is a process and it is not psychotherapy. A professional referral is given if it appears psychotherapy is needed.
I confirm that I have read, understood and agree with these terms.
Today's Date
*
MM
DD
YYYY
Thank you!