Inquiry to join Group Guided Meditations

Today's Date:

Referred By:

Full Name:

Your Email Address:

Phone Number:

Home Address:

Date of Birth - dd/mm/yy:

Place of Work:

Preferred method of contact:

Name & Relation of most important people in your life:

Name & Contact info for emergency:

What behavioral patterns/habits are you seeking to create or reinforce in your personal and/or professional life?:

What unwanted situations, relationships, and/or circumstances are you currently tolerating?:

I wnt to resolve the following challenges or problems:

I want to accomplish the following measurable or observable result:

I am ready to make the following fundamental changes/shifts:

What I need most from you, as my coach, includes:

I feel now is the right time to begin coaching because:

Also, I would like you to know that:

Agreement : Please type name to acknowledge agreement of the terms as laid out. I understand that I am working with Sheri Godfrey, Certified Life Coach & Guided Meditation Facilitator , at the agreed upon Introductory fee of $ 50 +HST for services. I agree to pay for the service prior to the beginning of services rendered-you will be invoiced. I agree to give 24 hours notice if I need to cancel my session, otherwise I will pay for my scheduled appointment in full. I acknowledge that Sheri Godfrey is not trained in any way to provide medical diagnoses, medical treatment, psychotherapy, or any other type of medical advice. I acknowledge that Life Coaching and Guided Meditation are tools for teaching individuals about themselves and that there is no guarantee of an outcome. The purpose of working with Sheri Godfrey is to provide life and relationship coaching, small business consulting, and holistic lifestyle instruction. All information will be held as confidential unless the client requests otherwise in writing.