Coaching Intake Form

Full Name

First NameLast Name

Preferred Pronouns

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Method of Contact

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Birthday!

Date

Have you mentored with Vitality Equine before?

Are you a business owner?

How long have you been in business?

What is your business, what services and/or products do you offer?

If your business does not exist yet, you can speak hypothetically here

What do you love about your business right meow?

It could be related to structure, organization, marketing, branding, revenue, expenses, taxes, social media, structure, services & products...anything!

What do you not love about where your business is at? What do you want to improve?

It could be related to structure, organization, marketing, branding, revenue, expenses, taxes, social media, structure, services & products...anything!

What are your intentions for your business in the next year? What about in the next 5 years?

Have you had a coach before?

What coaching program are you interested in participating in?

Connection Type. For our check-ins, do you prefer...

Other

Are you interested in attending the guest speaker event series (3-5 events) this year?

Other

What are you looking for in this coaching program? Check all that apply.

If you selected other, please clarify below

I understand that coaching services offered by Vitality Equine are never a replacement for a proper foundational course in equine massage therapy. These coaching experiences are intended to supplement existing knowledge. I understand that the Vitality Equine practitioner will not diagnose conditions, attempt any adjustments/musculoskeletal manipulations or prescribe medications, nutraceuticals or supplements for horses. I acknowledge that muscle releases may result in underlying muscle mechanisms being exposed that were previously masked through compensatory movements.

I understand that paying for coaching is part of creating a clean energetic exchange, not only for Vitality Equine's services, but for my own growth and development of my business. I understand that I have the option to pay my coaching dues via two types of payment plans: annually or monthly. If accepting the monthly payment plan, I will receive my invoice on the 1st of every month. I understand that I have 30 days to pay my invoice(s) before a 15% late fee incurs. I understand that I can pay my invoice via e-transfer, credit card (Mastercard or Visa), cash or cheque.

By signing this document I acknowledge that I have read and understand it and all of its provisions and I am signing voluntarily. I do hereby waive and release Vitality Equine from all liability, past, present and future.

Signature

Vitality Equine Coaching

Personal Information

Professional Information

Coaching

Waiver