Quick Coaching Submission Form
Quick coaching allows you to submit a specific question about a challenge you're having that can be answered in a time-limited format. Quick coaching is NOT counseling/psychotherapy and submitting a question on this form does not indicate the establishment of a therapeutic relationship. The response provided is considered psychoeducational in nature and is typically information that is readily available to the general public.
There is a non-refundable fee associated with quick coaching responses.
Complete the form below to receive a request for payment and a subsequent response to your question, concern or comment.
Enter your first name
Enter your last name or last initial
Enter your most reliable email address
Enter your preferred phone number (* must be a text-enabled mobile phone)
Indicate your understanding of the following information by checking the indicated boxes below. "Quick coaching works best with specific questions about a current challenge I'm having that can be answered in a time-limited format. Quick coaching is NOT counseling/psychotherapy and submitting a question on this form does not indicate the establishment of a therapeutic relationship with Dr. Medley or with New Day Psychological Services & Consulting (New Day PSC). The response provided by Dr. Medley/New Day PSC is considered psychoeducational in nature and is typically information that is readily available to the general public." All YES boxes below must be checked to receive a response.
Yes, I understand that I am not submitting a request for psychotherapy services.
Yes, I understand that submitting my quick coaching request does not indicate the start of a therapeutic relationship with Dr. Medley or with New Day PSC.
Yes, I understand that quick coaching is meant for specific questions that can be answered with a single response in a short time-frame.
Yes, I understand that I must pay the fee associated with quick coaching prior to being sent a response.
Yes, I understand that the quick coaching fee is non-refundable, even if I do not agree with the response I receive.
No, I do not understand or agree with either of the 5 statements presented above.
There is a non-refundable fee of $19.95 USD associated with being sent a quick coaching response. Choose your preferred payment method below (paper checks and cash are not accepted as payment).
Payment with credit card (Visa, Mastercard, American Express or Discover)
Payment through personal bank draft
Payment using Paypal (may be credit card, direct draft, Paypal credit or other approved method)
Submit your quick coaching question, concern or comment here.
How did you find out about the coaching services offered by New Day PSC/Dr. Medley (i.e., what or who was your referral source)?
Once your quick coaching submission is received, a payment invoice will be sent to the email address or mobile number you indicated above. A response to your quick coaching question/concern will be sent back to you within 2 business days after payment of your quick coaching fee is received. If you have questions or concerns about your payment or services prior to receiving your response, you may reach us at
Please enter today's date.
Thank you for submitting your quick coaching request.
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