Coaching Consultation Registration Prequalification for Coaching ConsultationAre you married? * Yes No * I am NOT in couple's counseling of any kind * I am NOT dating someone other than my spouse * There are NO legal orders restricting contact with my spouse * I am NOT in treatment for drug or alcohol abuseCONTACT INFORMATIONName * Name First First Last Last Email (BE SURE YOUR EMAIL ADDRESS IS CORRECT AND WORKS) * Town/City * State/Province * Country * Are you eligible for the 10% USA police/military rebate? Yes No For USA Military or Police: Upload proof of service for your 10% rebate * Drop a file here or click to upload Choose File Maximum upload size: 5MBCOACHING PREFERENCESPreference for Consultation Session * Phone Skype Zoom Phone Number * Skype Address * Email where you want the Zoom link sent * Preferred Coaching Time * Morning Afternoon Evening Anytime Specific days and times only... Specify availability for your time zone * Do you prefer a summary or mp3 recording of your session? * Bullet point summary Mp3 recordingLiving Situation * Living with Spouse NOT Living with Spouse How Old Are You? * Brief description of why you want a consultation * * I consent to the terms of the Coaching Agreement. If you are human, leave this field blank. Go to Package Options
