Joy Thinkers Intake Form

Joy Thinkers Intake Form

Collect essential client information for coaching sessions with Humanity 360, Inc.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
HealingAccountabilityLife GoalsCareer SupportOther
Please share any important information about yourself or your current life journey.
Once Per WeekTwice Per WeekOther
In Person MeetingsVirtual MeetingsHybrid (In-Person and Virtual)
Preferred Start Date*
Joy Thinker Menu*
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Name: A to Z

Name: Z to A

Price: Low to High

Price: High to Low

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One Session - $50
Single coaching session starting at $50

$50.00 Quantity



4-Session Package - $200
Package of four coaching sessions at $200

$200.00 Quantity



ADD ON: 1-on-1 45 Minute Yoga, Breathwork Session
$30.00 Quantity



Sliding Scale Request
Request for sliding scale payment option

$ Free Quantity



Total

$0.00
Sliding Scale Justification
How did you hear about us?
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