Client Registration Form |

I look forward to working with you in your upcoming session. The form below is sent directly to me and is not stored anywhere on this website, for your security. No financial information is requested here. As a reminder, as of May24, 2021, the fee for the first session is $198 and the fee for any follow-ups, is $170.

Although my information for receiving payments is included on the form below, please make a note of the info below for your use in setting up payment on one of these two payment platforms/apps:

Zelle ID: Elizabeth.Campbell2011@yahoo.com This is my preferred method of payment. It is a secure, bank to bank transfer.

Venmo: I would like to keep Venmo as an option for your convenience, but it will take your adherence to not putting in notes other than your name for me to be able to continue making this available to you.

In the note section, include ONLY the client first name and last initial, Do not put in ANY other notes!

Repeat: ONLY the client first name and last initial, Do not put in ANY other notes!

Venmo ID: @Elizabeth-Campbell-140 and follow the specific directions above.

Date *

Date of Birth Mo/Year *

Name *

First

Last

Email *

Phone with Area Code *

Address *

Profession or Occupation

What do you wish to achieve in the session/s?

Cancellation Policy *

I have read and agree to the cancellation policy below.

Should you need to change or cancel an appointment, it is necessary to do so by 9:00 AM the weekday prior to your session, so that time can be reassigned. A minimum of 2 hours is set aside for your appointment, and often your session times are allocated more time than that, especially for first appointments. Thank you for understanding the need for courtesy so that your time can be reassigned. from the waiting list. (There is no way to reassign from the waiting list for same day cancellations.) Real emergencies happen, so please reserve last minute cancellation for actual emergencies only.

Payments *

I agree to the terms below.

Payment through either Zelle or Venmo is required by 9:00 AM on the weekday prior to the start time of the session. This is to make sure that the time spent is only for the session itself. The new reality of online sessions and payments has been an adjustment for many. Much time has been spent helping people find and use their apps. I now have to ask you to do this work ahead of time. I appreciate your understanding. If you have questions, please feel free to reach out to me.

Signature of Client (If client is a minor, signature of parent or guardian) *

Phone

Client Registration Form

Email:

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