Client Intake Form
Pleae complete and submit before your appointment
Full Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please choose your Appointment option:
Long Distance Session
Google Meet
Although not required, you are welcome to share any information you feel pertinent to your Consultation/Session here.
Please choose your preferred Method of Payment so I can send you the relevant invoice at the end of the session.
PayPal
Stripe (Credit Cards)
e-Transfer
Date
-
Month
-
Day
Year
Date
Client Signature
Submit
Should be Empty: