Faith-Based Life Coaching

Faith-Based Life Coaching Intake Form

Please complete the form to book an individual coaching session with Dr. Ghia Kelly.
Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
Are you 18 or older?*

YesNo
If under 18, parent name

First NameLast Name
What do you want to focus on in coaching?
Do you prefer to meet in-person or virtually?*

VirtualIn-person (Tallahassee office)
How did you hear about my coaching services?

Web SiteFriend/ColleagueSocial MediaOther
Please Note:

This form uses Stripe Checkout. This allows you to pay using a credit card, Apple or Google Pay, Amazon Pay, Cash App Pay, or Afterpay (subject to approval).

If you wish to use ZELLE, please use coupon code "ZELLE" and send full payment to ghiakellycoaching@gmail.com.

Once this form is submitted and payment is received, a scheduling link will be emailed.
Signature (parent signature if under 18)*

Clear

My Products

Individual Coaching- 60 min$70.00

Quantity

Coaching Bundle - (3) 60 min sessions$175.00

Enter coupon

Total $0.00

Faith-Based Life Coaching Intake Form