Health Coaching
Explore your goals, concerns, and lifestyle, and how holistic herbalism can help. Find compassionate support and supportive motivation for your goals.
Your Name
First Name
Last Name
Who is this for?
I am requesting coaching for myself
This is a gift for someone else
Name of Recipient:
Recipient's email address
example@example.com
Message to Recipient (optional)
Contact Number
This is only for if I need to reschedule at the last minute. I do not store client phone numbers after the session.
Your Email Address
example@example.com
What health issues would you like to focus on?
*
What type of session will this be?
*
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( X )
First Session
1 hour
$
70.00
One follow-up session
30 minutes
$
35.00
Purchase five (5) follow-up sessions in bulk
30 minutes each. ($20 discount!)
$
155.00
Quantity
Half price sessions (available 1 day per month)
Last Sunday of each month, half price sessions are available for those in financial need.
$
17.50
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please list any medications you are taking
Is there anything important for me to know about you before we meet? Feel free to share what you are comfortable with. (Not required.)
What is your date of birth?
-
Month
-
Day
Year
Date
What time of day were you born, if known?
Please indicate AM or PM
In what city, state/province, and country were you born?
If purchasing multiple sessions: How often do you prefer to meet? (Note: the scheduling system I use does not handle repeated events, so I have to enter them manually. You will receive a calendar notification after I process your request.)
*
Weekly
Every other week
Once a month
Other: Enter your preference below
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