Mother-Daughter Therapy/Coaching
Client Information

1 Client Information
2 First Questionnaire
3 Second Questionnaire
  • Confidential

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  • Doctor´s Details

  • Office Policy

  • 1. Payment is due at, or before, the session. Services are fee-for-service only. It is up to the client to seek insurance reimbursement.
    2. If you need to cancel or reschedule your appointment, please give a full 48 hours notice, otherwise you will be charged for the session, regardless of reason. The only exception is adverse weather conditions for clients who travel to my office.
    3. Because there are clients booked in after you, I will not be able to make up the time if you are late for your appointment. If you are late, or do not show up, you will be charged for your appointment in full.
    4. For Skype or telephone appointments, telephone or Skype at your appointment time. I will be waiting for your call.
    5. If Skype fails, I can continue the session by calling your landline or U.S. cell.

  • My signature below declares that I understand and agree with the terms and conditions of the coaching/therapy relationship. I understand that I am responsible for my own actions and self-care, and coaching/therapy results are not guaranteed. I am entering into coaching/therapy with the full understanding that I am responsible for creating my own results.