Book A Session Fill out the form below and I will be in touch with you to schedule your first session. CONTACT & GENERAL INFORMATION Client Name * Address * City * State * Zip * Cell/Home Phone * Work Phone Email * Marital Status * Single Married Divorced CLIENT INFORMATION # of children Referred by: Birthdate * Background information you would like your coach to know: * Calendar of Available Time for coaching: (Days/Weeks/Hours) * Primary known objectives that you would like to address: * I am a Christian Life Coach, are you comfortable with prayer during our sessions? * C O O P E R A T I O N It is assumed that both parties will be in full cooperation with each other in the regards to the agreed upon coaching objectives. Neither party will withhold important information, which would benefit the coaching process, nor will either party act in any manner which would interfere with achieving the coaching goals in a timely manner. F E E S Coaching fees are based on the hours of service provided. We will meet and have follow-up sessions until you feel that you have accomplished your personal goals. The fee schedule is $35 per hour, with no retainer or long-term contract (Emails are always available between visits) 24 hour notice is requested for cancellation of the the coaching session. “No-shows” will be billed at the the scheduled hourly rate. A minimum of Four session $140 must be paid up front for first time Clients. C O N F I D E N T I A L I T Y Confidentiality and protection of intellectual property is mutually agreed to be protected by this agreement. Both parties agree that all data, information and work completed durning the course of corporate coaching will remain confidential. No information or materials will be shared with outside sources or other people regarding the work of either party, except with expressed written permission. M O D I F I C A T I O N S / E V A L U A T I O N S Either party may modify this agreement at any time it becomes apparent that modification is needed. The coach agrees to advise and influence ideas and actions—however the client is the final decision maker. Both parties agree to re-evaluate this agreement every 4-6 sessions. Signature (Type your name) * Submit If you are human, leave this field blank.
