Intuition Coaching Intake

Name *

First Name

Last Name

Birthdate

MM

DD

YYYY

Birth time

Must be exact.

Hour

Minute

Second

AM PM

Waiver

Rachel Psencik, the coach/consultant, recognizes that certain information of a confidential nature may be relayed during sessions. The coach/consultant will not, at any time either directly or indirectly, use this information for the coach’s benefit nor disclose said information to anyone else without specific approval of the client (excludes disclosure of illegal or unethical activities). Coaching and/or nutritional consulting is in no way to be considered or construed as psychological counseling or any type of therapy or replacement for a doctor’s care. Results cannot be guaranteed. The client agrees that they are entering into this session/program with the understanding that they are responsible for their own results. The client also agrees to hold the coach free of all liability and responsibility for any actions or results from adverse situations created as a direct or indirect result or specific referral or advice given by the coach/consultant. Should an appointment need to be rescheduled/cancelled, 24-hour notice is required. If the coach/consultant is not notified prior to 24-hours, the client forfeits the fees for that appointment.

Yes, I agree