Inspire Wellness: Personal Fact Sheet and Client Agreement
All personal information is strictly confidential and treated appropriately.
Full Name *
Email *
Address *
Cell Number
Home Number
Occupation *
Employer Name
Employer Address
Date of Birth *
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DD
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Marital Status *
Name of Significant Other
Significant Other's Date of Birth
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DD
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Names and Ages of Children
I understand that coaching does not provide treatment, therapy, or diagnosis and I agree to see my physician, therapist or qualified helping professional for such needs. I am the expert in my own life. I acknowledge full responsibility for myself to the best of my present abilities and awareness. I agree to wholeheartedly participate with my coach to make my coaching experience positive and useful. I agree to meet all financial responsibilities promptly unless other arrangements have been made. I understand that a charge will be made for all time reserved unless cancelled 24 hours in advance. Entering my name below acts as my electronic signature indicating that I understand and agree with these statements. *
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