2020 Learning Heroine LLC Scheduling Form
Email address *
Name *
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Address *
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Phone Number *
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Please check how you prefer to be contacted below: *
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Do you or your learner(s) have any allergies that the I should be aware of such as: walnuts, peanuts, perfumes, essential oils,or __________ ? This is helpful so the evaluator won't eat that food and then shake hands later, etc. Only share what is relevant or helpful. I value your privacy and don't need a health history, just anything to make our visit safe. (My middle child had an anaphylactic reaction to walnuts and almost died so allergies are very real to me.) *
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What service(s) do you wish to purchase? *
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When do you wish to meet? (Months optional for evaluations and other long-term service coordination) *
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How many of each service? *
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Preferred days, times? *
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Where do you wish to meet? (No Travel Fee) *
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A copy of your responses will be emailed to the address you provided.
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