Private Consultation Booking Form

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Date of Birth

Date

Occupation

Preferred Consultation Method

VirtualIn-OfficeSerene Space Outing

What are your primary health concerns? (Select all that apply)

What specific triggers do you believe are contributing to your anxiety?

Which of the following areas would you like to focus on during our session?

On a scale of 1 to 10, how would you rate your anxiety levels currently?

Please describe your main anxiety challenges:

Are you currently taking any medications or supplements?

Have you been diagnosed with any medical conditions?

What are your lifestyle habits? (Select all that apply)

What are your goals for this consultation?

Have you previously attended any sessions with an anxiety coach?

YesNo

On a scale of 1 to 10, how committed are you to working on your anxiety?

Appointment

Additional Comments or Questions

The Listening Spa Caribbean

Booking Policy

At The Listening Spa Caribbean, we are committed to providing our clients with the highest level of support and care. To ensure that all appointments are secured and run smoothly, we kindly ask that clients adhere to the following booking policy:

1. Booking Confirmation:

All appointments must be confirmed with full payment at least one day prior to the scheduled session. This policy is in place to secure your booking and ensure the best possible service.

2. Payment Options:

- Local Clients and Caribbean Nationals: Payment is to be made in full via bank EFT transfer. Please use the following details:

Bank: First Caribbean International Bank (FCIB)

Account Name: The Listening Spa Caribbean

Account Number:107080692

- International Clients: Payments may be made through PayPal. Please contact us for payment details if you choose this option.

3. Cancellation Policy: If you need to cancel or reschedule, please provide at least 24 hours' notice. Cancellations made less than 24 hours before the scheduled appointment may not be eligible for a refund.

By securing your booking, you agree to these terms. We appreciate your understanding and look forward to supporting you on your journey to wellness.

For any questions or concerns, please don't hesitate to contact us.

Serenity One-on-One Private Consultation Booking Form