• Love & Empowerment Professional Services

    Client Intake Form

  • Love & Empowerment Professional Services, is a DBA of Love & Empowerment Support Services, LLC.

    • Please select the service you are requesting. Complete one service request per submission.  
    • Which service are you requesting?
    • Client Information 
    • Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • FD-258 Ink Fingerprinting Card 
    • Service Details*
    • Fingerprint Card*
    • For a fee, would you like us to mail your fingerprint card to the requesting company via certified mail or priority mail?*

    •  

      Fingerprint Service Acknowledgment:

      Love & Empowerment Professional Services provides fingerprint capture services only. We do not perform or process background checks and cannot guarantee acceptance of fingerprints by any agency. The customer is responsible for providing the correct fingerprint card, ORI, agency information, and/or instructions when applicable. If a fingerprint card is supplied by Love & Empowerment Professional Services, the customer remains responsible for confirming that the FD-258 card is appropriate for their intended purpose. All sales are final and we do not allow refunds.

    • Date acknowledged*
       - -
      2 digit month, 2 digit day, 4 digit year
    • U.S Passport Photo Age 3 & Under 
    • Child's Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Relationship to child:*
    • Photo Service Requested*

    • Passport Photo Acknowledgment:

      I understand that Love & Empowerment Professional Services provides passport photo services but does not issue passports or make final determinations regarding photo acceptance. Photo acceptance is determined by the U.S. Department of State or other receiving agency. If a photo must be retaken due to an issue with the photograph produced by our office, I may contact the office for assistance. All sales are final and we do not allow refunds.

    • U.S Passport Photo Age 4 & Up 
    • Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Photo Service Requested*

    • Passport Photo Acknowledgment:

      I understand that Love & Empowerment Professional Services provides passport photo services but does not issue passports or make final determinations regarding photo acceptance. Photo acceptance is determined by the U.S. Department of State or other receiving agency. If a photo must be retaken due to an issue with the photograph produced by our office, I may contact the office for assistance. All sales are final and we do not allow refunds.

    • Date of Acknowledgement*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Visa Photo 
    • Photo Format Requested?*
    • Does the applicant have specific photo requirements from the requestingagency/consulate?*

    • Visa Photo Acknowledgment:

      I understand that visa photo requirements vary by country, embassy, consulate, and application type. I am responsible for providing any specific photo requirements applicable to my application. Love & Empowerment Professional Services will prepare the photograph according to the requirements provided but cannot guarantee acceptance by the receiving agency.. If a photo must be retaken due to an issue with the photograph produced by our office, I may contact the office for assistance. All sales are final and we do not allow refunds.

    • Date of Acknowledgement*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Professional Headshot 
    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Format: (000) 000-0000.
    • Photo/Editing Consent:*
    • Notary Services 
    • Type of Notary Service:*
    • Date Requested*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Does your document require a witness?*
    • Do you have a valid government-issued photo ID?*
    • Life Coaching 
    • Format: (000) 000-0000.
    • Preferred Method of Contact*

    • Personal Coaching Assessment:
      Please answer the following questions honestly. Your responses will help is understand your goals and create a coaching experience tailored to your needs.

    • Which area would you like to focus on during coaching?*
      • Coaching Agreement & Client Consent
        Please read the following information carefully. By signing below, you acknowledge that you understand and agree to the policies of Love & Empowerment Professional Services.
        Scheduling & Attendance
        *Coaching sessions are 60 minutes.
        *A 10-minute grace period is provided.
        *Clients arriving more than 10 minutes late may need to reschedule.
        *Missed appointments without notice are considered no-shows.
        Payment & Cancellation Policy
        *Payment is due before each session and non-refundable.
        *Appointments canceled with less than 24 hours’ notice may be charged the full session fee.
        *No-shows forfeit their payment.
        *All coaching fees are non-refundable.

      Coaching Agreement
      Life coaching is a collaborative process designed to help clients identify goals, develop strategies, and achieve personal and professional growth.
      Confidentiality
      Information shared during coaching sessions will be treated as confidential except when disclosure is required by law or when there is a risk of harm to yourself or others.

    • Date of Acknowledgement*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Certified Mailing & Shipping Service 
    • Return Receipt Requested?*
    • Resume Assistance 
    • Type of Assistance Needed*
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • I-9 Verification 
    • Do you have your Form I-9?*
    • Do you have the required original , unexpired identification documents?*

    • Client Agreement & Consent

    • By receiving services from Love & Empowerment Professional Services, I acknowledge that I am voluntarily requesting the selected service(s). I understand that fees are for services performed and that all sales are final once services have been rendered or processing has begun.

      I understand that Love & Empowerment Professional Services does not guarantee the acceptance, approval, processing time, delivery, background-check results, or outcome of documents, photographs, fingerprints, applications, mail, or other materials submitted to third-party agencies or organizations.

      I certify that the information I provide is accurate and complete. I understand that I am responsible for reviewing my information and documents for accuracy before they are finalized or submitted.

      I understand that missed appointments or no-shows may result in forfeiture of payments already made, according to the company’s cancellation and no-show policy.

      I authorize Love & Empowerment Professional Services to perform the service(s) I have requested and acknowledge that I have had an opportunity to ask questions before receiving services.

    • Date Signed*
       - -
      2 digit month, 2 digit day, 4 digit year
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