Intake Form - Find Peace Now

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INTAKE FORM

Once this form is submitted, you will receive the zoom invites, invoice & pre-work activities

First Name *

Last Name *

Date of Birth *

Street Address *

City *

Province / State *

Postal / Zip Code *

Country *

Country

Phone *

Email *

I consent to Find Peace Now sending emails to this email address

Brief description of your current challenges & goals you would like help with

Please note: For clients under the age of majority in jurisdiction where the Services are received, a parent or legal guardian must sign and thereby enters into this Agreement for themselves and on behalf of the client.

Full Name *

Name of Legal Guardian (if applicable)

Signature *

All information provided on this form, and during our sessions, is confidential. It will not be disclosed to anyone outside our coaching relationship without your written consent, except as required by law. This information is solely for the purpose of providing you with a personalized coaching experience.

By submitting this form, you acknowledge and consent to these confidentiality terms.

Karen Armstrong

karen@findpeacenow.com

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