Dare...............to Live Fully !!

Effective Transpersonal Life Coaching and Consulting in the office or via telephone or Internet

Welcome

Become a Client

Communication

Payments

Help Yourself

If you are interested in becoming an Internet client please complete the form below in it's entirety and click the SEND button. Sending this form implies that you have read and agree to the statement of understanding.  I will contact you via email once I receive the completed form and we will then discuss establishing a professional relationship. Please be aware that submitting this information does NOT automatically establish a professional relationship.

A reminder that my services are not psychotherapy, but assisting you with formulating and implementing your life goals. If you feel the need for psychotherapy please contact a therapist in you local area.


First Name
Last Name
Address Line 1
City
State
Zip Code
Country
Daytime Phone() -
Evening Phone() -
E-mail Address
your gender and age
Your preferred session times
Please indicate that you agree to the Client Statement of Understanding
If you are going to use an Instant Messager program for your sessions please indicate which one, and the screen name you will be using.
Please describe the initial goals you would like to work on.
Effective coaching for your life goals