Prophetic Coaching Questionnaire

Coaching Intake Form
SERIOUS INQUIRIES ONLY! THIS IS A $1000 INVESTMENT.

Please provide the following information to help us better understand your need for Prophetic Coaching. The information collected will be used for the sole purpose of determining your eligibility for the service.
INVESTMENT

The Investment for a 1-on-1 session with Prophet Sergio Nazir Chavez is $1000 for 90 minutes. Payment must be received in full when booking your session. Multiple sessions can be booked thereafter if necessary upon discussion and agreement with Prophet Sergio Nazir Chavez.
REQUIREMENTS

Coaching sessions are done via Zoom. Prophet Sergio requires that your Camera is ON during the session, that your microphone is working properly, and that you are in a well lit area. It is also required that you are properly dressed to respect the Prophet. Failure to adhere to these requirements could lead to the cancellation of your session.
Client Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please provide a cell phone number where you can receive text communication if needed.
Client Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Date of Birth*

MonthDayYear
Date
What is your marital status?*

SingleMarriedDivorcedWidowed
Do you have children?*

YesNo
Sex*

MaleFemale
Requirement verifications
Do you have access to Zoom?*

YesNo
Do you have a working camera and microphone to be on Zoom?*

YesNo
I acknowledge that I must be in a place with good lighting and properly dressed for my session.
Tell us about your inquiry
Why are you requesting a 1-on-1 with Sergio Nazir Chavez? (ex: business, ministry, leadership, etc)
If applicable, how long have you been in ministry and/or business?
What do you expect from this 1-on-1 session?
Please add anything else you'd like us to know as we consider your application.
I acknowledge that this is a $1000 investment. If my application is approved, I can make that investment for Prophetic Mentorship.
*Your signature below indicates that the information you have provided above is truthful.
Date*

MonthDayYear
Date
Signature*

Powered by Jotform SignClear
Should be Empty:

Coaching Intake Form

SERIOUS INQUIRIES ONLY! THIS IS A $1000 INVESTMENT.

INVESTMENT

REQUIREMENTS

Requirement verifications

Tell us about your inquiry