4everVernice's Intake Form
4everVernice LLC provides many services for our clients which includes teaching, coaching, and accounting. The goal of these services is to help our clients live healthier and wealthier God's way in body, spirit and soul. Please complete all form fields to start the working relationship with 4everVernice LLC.
Best Phone Number to Reach You:
What is Your Faith?
New Age Spirituality
How many of these wealth challenges/success are you having? (check as many as apply)
Personal assets liquidated
Credit record impacted for 10 years
Threatening phone calls and letters from creditors
Credit card maxed out
Begin working two or three jobs
Expenses exceed income
Only able to make minimum payments
Handle emergencies with credit cards
Income = Expenses
Consistently prevent any attempts to save
Lots of worry, anxiety and fear about the future
Income greater than expenses
Bills consistently paid on time
3-6 month emergency fund has been established
No worries about debt, investments, or material things
Consistently using surplus funds for meeting needs of God's peple
Eight sources of income
Keeping track of income and expenses
Keeping track of assets, liabilities and equity
Successfully building my audience for my brand
How many of these health challenges/success are you having? (check as many as apply)
Difficulty getting up in the morning
Continual fatigue, not relieved by sleep and rest
Lethargy, lack energy to perform normal, daily activities
Increased effort needed for everyday task
Decreased interest in sex
Decreased ability to handle stress
Increased time needed to recover from illness, injury or traumas
Light-headed or dizzy feeling when standing up quickly
Low emotional mood
Less enjoyment or happiness with life
Increased Premenstrual Syndrome symptoms
Symptoms worsen if meals are skipped or inadequate
Thoughts are less focused, brain fog
Memory is poor
Decrease tolerance for stress, noise, disorder
Not fully awake until after 10 am
Afternoon low between 3 and 4 pm
Feel better after supper
Get a "second wind" in the evening and stay up late
Decreased ability to get things done - less productive
Have to keep moving - "If I stop, I'll get tired"
Feeling overwhelmed by all that needs to be done
It takes all my energy to do what I have to do - there's none left over for anything or anyone else
Withdrawal from family and friends
Reached my weight loss goal
Lots of energy throughout the whole day
Inner joy in abundance
I'm able to stick to my meal plan for lifetime
What services would you like from 4everVernice?
How did you hear about 4 Ever Vernice LLC?
Select Your Desired Starting Date and Time
4 Ever Vernice LLC Disclosure Statement
All the services that I provide was created to help you live healthier and wealthier God's Way in your body, spirit and soul. I do not practice as a medical professional, but as a health and wealth minister that provides mentoring, teaching, coaching and consulting services.
Your success, is based on your level of effort. More effort you put forth, the better results you will experience.
Your identity will be kept confidential. I will only release information with your written permission unless you are at risk to yourself or someone else.
To start our working relationship, you will be charged a setup fee of $400.00 to cover the cost of providing services to you. Then I will send you an invoice of additional costs (if applicable). To request an updated price list, please email
. To make your payment, visit
. There are no refunds, but payments can be transferred to other 4everVernice services.
I will set and keep appointments. Give at least 24 hours notice for any missed appointment.
I will pay $400 setup fee and the rest of fees according to agreement.
I will help plan and follow through on my agreed upon goals.
I am aware of the limits of confidentiality
My signature attests that I have read, and fully understand my rights as a client.
A copy of your responses will be emailed to the address you provided.
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