NEUROHARMONY: An 8-Week Nervous System Regulation & Healing Immersion ✨🌿🧘‍♀️

NEUROHARMONY: An 8-Week Nervous System Regulation & Healing Immersion ✨🌿🧘‍♀️

Please fill out this intake and agreement form to begin your healing journey with Rebecca K Coaching.
Client Information
Welcome to NeuroHarmony — an integrative coaching experience designed to support nervous system regulation, resilience, and deeper wholeness through personalized coaching, biofeedback, and holistic healing practices.
What’s Included
Investment in Your Healing
Private Program Investment: $975*. Includes the full NeuroHarmony Immersion plus HeartMath sensor. Payment Options: Pay in Full — $975. Payment Plan — 4 payments of $250 every other week ($1,000 total).

*This is a founding circle rate for this new program and will increase to $1250 on June 30th, 2026.
Program Policies
Payment Terms: First payment is due upon enrollment to reserve your space. Client agrees to complete all scheduled payments regardless of attendance.
Refund Policy: Because this is a personalized coaching experience and your space is reserved, all payments are final and non-refundable.
Scheduling & Rescheduling: One complimentary reschedule is included with at least 24 hours notice. Additional missed sessions may be forfeited unless otherwise agreed.
Informed Consent & Confidentiality
Coaching Disclaimer: This program provides coaching and education to support nervous system regulation and wellness and is not medical care, psychotherapy, counseling, diagnosis, or treatment. Coaching is not a substitute for licensed medical or mental health care.
Client Responsibility / Informed Consent: Client understands that growth and nervous system work may bring awareness to emotional material and agrees to seek licensed support when appropriate. Client accepts responsibility for their own care and participation.
Confidentiality: All information shared in sessions will be kept confidential except where disclosure is required by law or where there is concern of harm to self or others.
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Initial Intake Reflection
What is calling you into this healing journey at this time?
What significant life experiences have shaped your stress or healing journey?
What are your current life stressors?
What is your current approach to nourishment and diet?
What physical health concerns would you like support around?
What emotional health concerns would you like support around?
How would you describe your spiritual life in this season?
Are you ready to commit to this 8-week healing immersion?
What transformation or outcomes are you hoping for through this process?
Client Agreement
I have read, understand, and agree to the terms of this agreement.
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Your NeuroHarmony Immersion includes: Eight private 1:1 coaching sessions (60 minutes each); personalized nervous system regulation coaching; HeartMath biofeedback sensor and training; customized practices and support resources; optional between-session support, if applicable.
Assumption of Risk and Release of Liability: Client voluntarily assumes any risks associated with participation and releases Rebecca K Coaching from liability related to participation in this coaching program.
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NEUROHARMONY: An 8-Week Nervous System Regulation & Healing Immersion ✨🌿🧘‍♀️

Client Information

What’s Included

Investment in Your Healing

Program Policies

Informed Consent & Confidentiality

Initial Intake Reflection

Client Agreement