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Holistic Life Coaching - Contract Application

Holistic Life Coaching for Body, Mind, Heart and Spirit

To initiate a coaching partnership please fill out the form below then go to the Payment Page.

To pay by certified check or money order, E-mail me for further directives. If you're ready to invest in you
fill in this contract form today! I'll rush your introductory package and contact you immediately to set
up a schedule that suits your needs. Invest in yourself!

Healing Intent Coaching Service Form


What is your full name?



What is your street address?



What city do you live in?



What country do you live in?



What is your zip or postal code?



What is your phone number?



What is your email address?



What is your occupation?



How old are you? (must be 18 or over)



Which is your marital status?



Coaching Deivery Mode Preferred:(check off your choice)

E-mail Coaching:
$199/mo
Postal Mail Coaching:
$199/ mo
Web Coaching:
$299/ mo

Skype Coaching:
Monthly: $75/mo
Biweekly: $140/mo
Weekly: $250/mo
2x/Week: $399/mo

Chat Coaching:
Monthly: $50/mo
Biweekly: $90/mo
Weekly: $160/mo
2x/Week: $280/mo




| Introduction | Credentials | Support | Development |
| Delivery | Contract | Order | Contact |

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June Kaminski, MSN, PhD Candidate- 2001 - 2012 -Healing Intent.com - All rights reserved.
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