Financial Agreement

Contact Info

Name

First*

Last*

Email

Email*

Address

Street

City State Zip

Phone

Daytime Phone
..

Evening Phone
..

Cell Phone
..

Birthday

Birthday ,

Services and Financial Information

Please check the services we have agreed to and complete the Financial Information.

Two(2) 45 minute coaching sessions and retainer** services at $100/month (3 month minimum) Three(3) 45 minute coaching sessions and retainer** services at current $150/month (3 month minimum) One(1) 45 minute coaching session for maintenance at $50/month - NOTE: ONLY AVAILABLE WITH ONE OF THE ABOVE OPTIONS - NOT AVAILABLE AS A STAND ALONE OPTION
**Retainer service refers to my extra availability to you between our scheduled sessions(email, fax and/or brief calls)

Check Number

Terms

I confirm that I have read the guidelines listed in the “Welcome Packet” and agree to abide by them. As a coaching client, I understand and agree that I am completely responsible for my well- being during my time of 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 it is needed.

I agree to the above terms*