Coaching > Payment Method

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This information will help us to keep our books and your sessions in order. If you have any questions or concerns, please contact Jacqueline Quarrie

This form is secure, and your information on this form (or any other form) will never be shared. All information is kept completely confidential.

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Payment Method

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Please confirm your start date for your first session

Session Options

Weekly

Bi-Weekly

Weekly

5 Session Package

Payment Options

Per Session

Package Fee

Payment Method

E-transfer

Paypal

Visa/Mastercard

FOR AUTOMATIC BILLING, you can provide your Visa/Mastercard information

Visa Mastercard Expiry Date

Visa/Mastercard CVC (on back of card)

Your name exactly associated with your Visa/Mastercard

DISCLAIMER: The Client is aware that the coaching relationship does not represent psychological counselling or any kind of medical therapy. The client is also aware that coaching results can vary and are not guaranteed results. They are provided to help discover your next level. The Client agrees that they are entering into coaching with the understanding that the client is responsible for their own decisions and results. The Client also agrees to hold the Coach free from all liability for any actions or results for adverse situations created as a direct result of advise given by the Coach. Type your name in the space provided.

SESSION CONTACT PROCEDURE: The Client shall contact the Coach at the agreed hour. If the Client fails to make the appointment time, the Client is still responsible for the coaching fee, unless 24 hours notice was given to reschedule the call. The Coach will make every effort possible to reschedule the session at a mutually agreeable Type your name in the space provided.

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Coaching > Payment Method

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Payment Method

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