Client Inquiry Form 

If you are here, there is a reason. Do you feel like it's time to do something different? Do you want to stop working so hard but are terrified nothing would work without you holding everything together?


You are a heart centered person, putting others first. You have spent years catering to the needs of others while ignoring your own. You are exhausted from giving it your all, from people pleasing, and from working diligently to get it right. But now you are on empty.


The fact you are considering investing in 1:1 coaching means you are ready to stop tolerating this for yourself. You've had enough.


Welcome to the journey of wholeness as you work on the most important relationship - the relationship with yourself. I'm so glad you are showing up for yourself today. Please complete this form (All information is strictly confidential). Please be advised that you may not receive an immediate response and you may be on a waitlist to begin working with Ashley.


Ashley Pitzer | Practicing Life LLC 

Email *
Legal First and Last Name *
Preferred Name *
Address: City, State, Zip, and Country  *
Cell # *
Date of Birth *
Email Address *
Pronouns *
Marital Status *
Have you ever sought coaching before? And if so, please explain:   *
Have you ever been treated for: (This is for hypnosis purposes only)
Have you ever been hypnotized before? *
Required
What do you want to accomplish through the use of hypnosis and/or coaching?  *
Any previous efforts to solve this problem, and what were the results?  *
Do you have any fears or phobias?  *
How did you hear about me? *
Will you commit to 60-75 minute sessions one time per week for the duration agreed upon- if both parties agree to work together?  *
Required
Do you agree to the below?   *

As part of working with Practicing Life LLC/my Coach, I am willing to be guided through relaxation, visual imagery, creative visualization, hypnosis, and stress reduction processes and techniques for the purpose of vocational or avocational self-improvement.  I understand that the hypnotherapy is not a substitute for normal medical care and I have been advised to discuss this hypnotherapy with any doctor who is taking care of me now or in the future.  Additionally, I should continue any present medical treatment and consult my regular medical doctor for treatment of any new or old illnesses. 

Furthermore, I understand that working with Practicing Life LLC is not a substitute for seeking the appropriate professional for my mental health for issues that fall outside the scope of self-improvement. I understand that the coaching services provided by Practicing Life LLC/my Coach are not offered as a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that my Coach is not acting as a mental health counsellor or a medical professional.


***Filling out this inquiry form does not guarantee or obligated either myself or Practicing Life LLC to work together.  This is not a contract and does not include all service terms or conditions. ***


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