Name *

First Name

Last Name

Birthday

MM

DD

YYYY

Relationship Status

Married

Partnered

Divorced

Separated

Single

Situationship

I understand the following: Transformational work can be uncomfortable at times; personal growth requires active participation, willpower, courage and persistence; and while I can receive skillful, individualized support, I am the only one responsible for my healing and evolution. *

Understood!

ACKNOWLEDGMENT OF CANCELLATION POLICY: Please only book appointments you prioritize attending and immediately mark them on your calendar to avoid scheduling mishaps. If absolutely needed, clients are allowed to cancel or reschedule sessions up to 24 hours before the appointment. Giving longer notice is always preferred as it gives me more time to fill the vacancy. No-shows, last minute reschedules or cancellations made within the 24-hour window will be expected to pay half of the fee owed. I understand that unforeseen emergencies and illnesses come up and I can waive the fee for these occasional occurrences. However, missed appointments due to a client’s scheduling error will be charged the cancellation fee. Additionally, repeated cancellations or reschedules may be grounds for termination of service. Checking the box below confirms your acknowledgment of this policy. *

Understood!

Select a preference for your session:

PHONE CALL SESSION

ZOOM SESSION

IN-PERSON SESSION (in Nevada City, CA)