check

2022 Private Coaching Intake Forms

Please fill out, read, and submit at least 48 hours before your first private session appointment.

After that, this is a one-time per year form submission.  If you have already submitted this form for this year for yourself and anyone else you are responsible for, you are complete.

Failure to submit Forms will result in spending time during the session to complete rather than coaching.

Click the button below to start.

Start

2022 Private Coaching Intake Forms

For Peggy Nazer Coaching

2022 Private Coaching Consent Forms

SUBMISSION GUIDELINES

FOR

RELEASE FORM

AND

HOLD HARMLESS FORM

 

Both forms must be submitted each year by the following:

Clients 18 and older who are also the Party Responsible for Payment

Clients 18 and older who are not  the Party Responsible for Payment (in addition, the Party Responsible also submits these forms.)

The Parent/Guardian of a Minor-aged Client

The Party Responsible for Payment (this is either the parent/guardian or another party.)  NOTE:  If the Parent/Guardian is NOT the Party Responsible for Payment, then the Responsible Party must submit a separate form.

 

Please make sure all involved parties submit these forms.
 

If you have any questions or concerns, please email me:

[email protected]

 

Personal Information on Intake Forms

Your Information is never shared or sold!

 

Correct contact information is vital.  It is used here primarily for communicating about appointments:  questions, scheduling, appointment confirmations, rescheduling, and reminders.  Please include the client's contact information - 14 years old and older - to help make sure communication is open, up to date, and helping everyone arrive at sessions on time.

 

NOTE TO PARENT: A section is reserved for personal information for young clients' (aged 13 and younger). You may fill out one form for your children 13 and younger that participate in coaching rather than fill out a form for each child.  However, clients 14 and older must have their own Form.

 

STEPS TO COMPLETE THIS FORM

 

The intake system has some limitations, and therefore, you will see fields that need a duplicate answer.  In these cases, please write out the correct answer again, instead of "same as above" type answers.

Some fields may not apply to you, but you will need to read and answer those, too (write N/A in those.)

 

Please fill out all fields correctly to complete the Form.

 

The 2022 Private Coaching Consent Forms are not complete unless you check all the boxes, including both the boxes under each Form, signifying you have read and agree to both the Release & Hold Harmless Forms.

 

I appreciate your patience!

 

 

 

Question 4 of 71

Your Email:

Question 5 of 71

Your Name:

Question 6 of 71

Please state, using the exact phrases written in bold, the position that describes you best:

 

#1  The Client - Party Responsible for Payment (You or your spouse pays for enrollment.)

 

#2  The Client - Not Responsible for Payment (This answer typically applies when the client's enrollment is paid for by a parent/guardian. NOTE:  client's under 18 do not fill out this form.

 

#3  The Parent/Guardian - Party Responsible for Payment

 

#4  Party Responsible for Payment - Not Guardian (This answer typically applies if another relative, a friend, or clergy is paying for the client's enrollment.)

 

After reading through the descriptions above, the position that describes me best is:

Question 7 of 71

If you selected "#4  Party Responsible for Payment - Not Guardian" above - you are NOT the parent or guardian but ARE the party responsible for payment - please state your relationship to the client (N/A if doesn't apply):

Question 8 of 71

Is the Client a Minor-aged child? ("Yes" or "No")

Question 9 of 71

Name(s) of Parent/Guardian:  ("N/A" if it doesn't apply.)

Question 10 of 71

Email of Parent/Guardian:  ("N/A" if it doesn't apply.)

Question 11 of 71

Mobile Phone of Parent/Guardian:  (N/A if it doesn't apply.)

Question 12 of 71

Personal Information for Client(s) 13 & younger.  If you have more than one child younger than 13 participating in private or group sessions, put their information on a separate line.  Fill out a separate form for all children 14 & older.

 

#1 Child's Name,  Age, Date Of Birth (mm/dd/yyyy)

#2 Child's Name, Age, Date Of Birth (mm/dd/yyyy)

 

Put N/A if this doesn't apply.

Question 13 of 71

Client's Name (14 & older, put N/A if the client is younger):

Question 14 of 71

Client's Age (14 & older, N/A if doesn't apply):

Question 15 of 71

Client's Date of Birth (mm/dd/yyyy) (for clients 14 & older, "N/A" if younger):

Question 16 of 71

Client's Email (14 & older,  put "N/A" if younger):

Question 17 of 71

Client's Mobile Phone (14 & older,  put "N/A" if younger):

Question 18 of 71

Name of Party Responsible for Payment:

Question 19 of 71

Email of Party Responsible for Payment: (please list email attached to PayPal payment here.)

Question 20 of 71

Mobile Phone of Party Responsible:

Release Form

For Private Coaching Sessions

Question 22 of 71

 

 

I, _________, understand that nothing said, done, performed, typed, printed, or produced by Peggy Nazer is intended or meant to diagnose, prescribe, treat a disease or take the place of diagnoses by a licensed physician, psychologist, or psychiatrist.

 

Consultations by phone or email, training, coursework, private and/or group coaching sessions, energy psychology work sessions, Integrative Processing Technique (IPT) sessions, integration sessions, classes, or techniques are to promote healthy lifestyles and cultivate the mind/body connection.

 

A variety of non-invasive methods, modalities, and programs, commonly referred to as Energy Psychology, may be used, which include but are not limited to, bio-kinesiology (muscle response testing-MRT). MRT is used to determine past events and identify negative emotions stored in certain chakras or energy centers of the body.  In addition, guided imagery, NLP, speaking out feelings, role-playing, inner child work, chakra work, visualization and various Energy Psychology techniques are used.  The purpose of using these techniques is to bring the Client to a place of inner healing/reconciling and a strong sense of well-being and closure with the issues being addressed.

 

This form is a release form granting Peggy Nazer permission to release and clear negative energy and process my family member or me through experiences using both conscious awareness and energy release techniques.  This authorization is valid for any and all private and group sessions as well as any coursework involving Peggy Nazer.

 

(Select all that apply)
A

I agree that these Terms and Conditions apply to all of my minor-aged children that I choose to enroll in Peggy Nazer's services and for any adult children for whom I am paying for Peggy Nazer's services.

B

I have read and agree to these Terms and Conditions. I understand that submitting this form serves as my electronic signature

Question 23 of 71

Type your name as it would appear on a Signed Document:

Hold Harmless Form

For Private Coaching Sessions

Question 25 of 71

 

 

In consideration of receiving life coaching & energy psychology work from Peggy Nazer (DBA Peggy Nazer Coaching), I hereby release, waive and discharge all rights to legal action against and covenant not to sue, and agree to forever hold harmless for any and all purposes, Peggy Nazer Coaching from any and all liabilities, claims and/or demands that may result from coaching and/or energy psychology work, provided by Peggy Nazer Coaching.

 

My election to receive coaching & energy psychology work or any other services provided by Peggy Nazer Coaching is completely voluntary and at my own discretion.  I also hereby acknowledge that Peggy Nazer Coaching does not make any promises or guarantees that her methods will help or cure me of any type of condition or health problem. I voluntarily assume full responsibility for any risks or outcomes that may result from receiving coaching or energy psychology work, whether caused by commission or omission on the part of Peggy Nazer Coaching.

 

It is my expressed intent that this Covenant Not To Sue and Hold Harmless Agreement shall bind the members of my family, spouse, heirs, and their families and personal representatives.  I acknowledge and represent that I have read the foregoing Covenant and Agreement, understand it, and voluntarily agree to it, and its terms in full as my own free act and deed; no oral representations, statements, or inducements apart from the foregoing agreement that has been reduced to writing have been made.  I execute this document as full, adequate, and complete, fully intending to be bound by the same, now and in the future.

 

(Select all that apply)
A

I agree that these Terms and Conditions apply to all of my minor-aged children that I choose to enroll in Peggy Nazer's services and for any adult children for whom I am paying for Peggy Nazer's services.

B

I have read and agree to this Covenant and Agreement. I understand that submitting this form serves as my electronic signature

Question 26 of 71

Type your name as it would appear on a Signed Document:

Question 27 of 71

Clients 18 years and older are required to complete all Intake Forms.  In addition, parents of Minor Clients AND the Party Responsible for Payment of Services are also required to complete all Intake Forms.  Submit separate forms where necessary so that all documents are received from all required parties.

 

Private Session forms are due at a minimum of 48-hours before the session.  If documents are not received, then completing the forms will be the priority in the session.  No extra time will be allotted to the session to make up for time spent on forms.

 

(Select all that apply)
A

I understand that these Intake Forms must be submitted by clients 18 years and older, by parents on behalf of minor clients, AND by the party responsible for payment. Failure to fill out all fields and submit both forms 48-hours a private session will prioritize completing and submitting all necessary forms. No extra time will be allotted to the session to make up for time spent on forms.

Question 28 of 71

Please review all personal information to make sure it is correct and complete before submitting it.  Missing or inaccurate information can result in using session time to finish the paperwork.

 

(Select all that apply)
A

I have reviewed all information on this form and certify that it is correct and complete.

Question 29 of 71

Please state, using the exact phrases written in bold, the position that describes you best:

 

#1  The Client - Party Responsible for Payment (You or your spouse pays for enrollment.)

 

#2  The Client - Not Responsible for Payment (This answer typically applies when the client's enrollment is paid for by a parent/guardian. NOTE:  client's under 18 do not fill out this form.

 

#3  The Parent/Guardian - Party Responsible for Payment

 

#4  Party Responsible for Payment - Not Guardian (This answer typically applies if another relative, a friend, or clergy is paying for the client's enrollment.)

 

After reading through the descriptions above, the position that describes me best is:

Question 30 of 71

Your name as it would appear on a signed document:

2022 Private Coaching Policies & Procedures Agreement

For Peggy Nazer Coaching

2022 Private Session Policies & Procedures

FORM SUBMISSION GUIDELINES

 

As this form is updated, it must be submitted each year by the following:

 

Clients 18 and older who are also the Party Responsible for Payment

Clients 18 and older who are not  the Party Responsible for Payment (in addition, the Party Responsible also submits these forms.)

The Parent/Guardian of a Minor-aged Client

The Party Responsible for Payment (either the parent/guardian or another party.)  NOTE:  If the Parent/Guardian is NOT the Party Responsible for Payment, the Responsible Party must submit a separate form.

 

Please make sure all involved parties submit these forms.

 

**PARENT NOTE:  If the Client and the Party Responsible are NOT the same people, then the Parent/Guardian (Responsible Party) will first need to book and complete two Private Sessions as a Client before I will begin working with the dependent child.  Parents, in this case, you will fill out this form first with yourself as the Client.  Later, you will fill out this Policies Form as a Parent/Guardian for your child after you have completed your sessions.**

 

A Parent/Guardian submits the form for a minor-aged Client only after the Parent/Guardian has completed at least two Sessions.  If the Parent/Guardian is NOT the Party Responsible for Payment, then a separate form must be submitted by both parties. 

 

 

If you have any questions or concerns, please email me:

[email protected]

 

 

 

Personal Information

Your Information is never shared or sold!

 

Correct contact information is vital.  It is used here primarily for communicating about appointments:  questions, scheduling, appointment confirmations, rescheduling, and reminders.  Please include the client's contact information - 14 years old and older - to help make sure communication is open, up to date, and helping everyone arrive at sessions on time.

NOTE: A section is reserved for young clients' (aged 13 and younger) personal information. You may fill out one form for your children 13 and younger that participate in coaching rather than fill out a form for each child.  However, clients 14 and older must have their own Form.

 

STEPS TO COMPLETE THE FORM

 

The intake system has some limitations, and therefore, you will see fields that need a duplicate answer.  In these cases, please write out the correct answer again, instead of "same as above" type answers.

Some fields may not apply to you, but you will need to read and answer those, too (write N/A in those.)

 

Please fill out all fields correctly to complete the form.

The Private Session Policies & Procedures Form will not register as complete unless you check all the boxes, signifying you have read and agree to all Policies & Procedures.

 

I appreciate your patience!

 

 

Question 34 of 71

Your Email:

Question 35 of 71

Your Name:

Question 36 of 71

Please state, using the exact phrases written in bold, the position that describes you best:

 

#1  The Client - Party Responsible for Payment (You or your spouse pays for enrollment.)

 

#2  The Client - Not Responsible for Payment (This answer typically applies when the client's enrollment is paid for by a parent/guardian. NOTE:  client's under 18 do not fill out this form.

 

#3  The Parent/Guardian - Party Responsible for Payment

 

#4  Party Responsible for Payment - Not Guardian (This answer typically applies if another relative, a friend, or clergy is paying for the client's enrollment.)

 

After reading through the descriptions above, the position that describes me best is:

Question 37 of 71

Is the Client a Minor-aged Child?  ("Yes" or "No")

Question 38 of 71

Parent/Guardian Name if the Client is a minor:  (N/A if it doesn't apply)

Question 39 of 71

Parent/Guardian Email if the Client is a minor:  (N/A if it doesn't apply)

Question 40 of 71

Parent/Guardian Mobile Phone if the Client is a minor: (N/A if it doesn't apply)

Question 41 of 71

Personal Information for Client(s) 13 & younger.  If you have more than one child younger than 13 participating in private or group sessions, put their information on a separate line.  Fill out a separate form for all children 14 & older.

 

#1  Child's Name, Age, Date Of Birth (mm/dd/yyyy)

#2 Child's Name, Age, Date Of Birth (mm/dd/yyyy)

 

Put N/A if this doesn't apply.

Question 42 of 71

Client's Name (14 & older, put N/A if the client is younger):

Question 43 of 71

Client's Age (14 & older, N/A if the client is 13 or younger):

Question 44 of 71

Client's Date of Birth (dd/mm/yyyy) (N/A if the client is 13 or younger):

Question 45 of 71

Client's Email (14 & older, N/A if the client is 13 or younger):

Question 46 of 71

Client's Mobile Phone:  (put N/A if the client is 13 or younger)

Question 47 of 71

Name(s) of Party Responsible for Payment:

Question 48 of 71

Email of Party Responsible for Payment (please list the email attached to PayPal payment.) :

Question 49 of 71

Mobile Phone of Party Responsible for Payment:

2022 Private Coaching Policies & Procedures

For Peggy Nazer Coaching

 

Question 51 of 71

Steps After Booking:

 

  • Complete and submit the first private session Forms 48 hours before the appointment time.
    • You click on the links provided- just as you did to get to this form.
  • Complete and submit the regular session Form 24 hours before appointment time (sent via email upon booking).
  • Submit PayPal invoice 48 hours before appointment time (sent via separate email).  NOTE:  Because the billing email is sent later, choose to pay at the time of booking if you are scheduling 3 or fewer days in advance to avoid late payment.
  • Contact me at appointment time:  801.772.0176

(Select all that apply)
A

I understand the steps to complete after booking

B

I understand I need to submit forms for my first private session 48 hours before my appointment

C

I understand I need to submit payment 48 hours before my appointment

Question 52 of 71

Deadline Policy:

 

To make the most of your session; many housekeeping items have deadlines that help me streamline the booking, intake forms, and payment processes.

 

A 48-hour deadline to submit your first private session Forms.

 

A 48-hour deadline to submit Cancellations, Reschedules, and Payment.

 

A 24-hour deadline to submit your regular session Form.

 

 

(Select all that apply)
A

I have read, understand, and agree to the 48 Hour Deadline for my first private session Forms submissions

B

I have read, understand, and agree to the 48 Hour Deadline for Cancellations, Reschedulings, and Payment

C

I understand I have a 24 Hour Deadline for my regular session Check-In

Question 53 of 71

Intake Forms Required:

 

  Before the First Private Session and Yearly Thereafter:

 

       Peggy Nazer Coaching Policies & Procedures for Private Sessions Form

       Intake Forms - Release Form & Hold Harmless Form

       New Client Questionnaire

  

Before All Other Sessions:

 

        Pre-appointment Check In

 

(Select all that apply)
A

I understand which Intake Forms are required before the first private session

B

I understand which Intake Forms are required before all other sessions

Question 54 of 71

Intake Form Submission According to Age:

 

Having the proper forms and feedback from all interested parties in advance increases the quality of your sessions.  Failure to have all documents submitted by all the correct parties 48 hours before the Introductory Session time can result in more time spent on paperwork instead of coaching.  Extra time will not be added to the session to make up for the time used on paperwork.

 

Here are the requirements on who submits which forms:

 

  • Clients 18 years and older and are the Party Responsible for Payment must submit all forms.
  • Clients 18 years and older must submit all forms, even if they are NOT the Party Responsible for Payment.
    • If the client is NOT the Party Responsible for Payment but is still considered a dependent, then the Parent/Guardian/Party Responsible will also submit all forms.
  • Parent/Guardian/Party Responsible for Payment must submit all intake forms for children considered a dependent (single child age 24 or younger, or older child with special needs)
    • Submit background information and observations about the child for each session.
    • This includes the "New Client Questionnaire" and "Pre-Appointment Check-In."
  • Parent/Guardian/Party Responsible for Payment must submit all intake forms for adult children whose service they are paying for.  (ex. married child, 25 or older.)
    • This includes the "New Client Questionnaire" but DOES NOT include the "Pre-Appointment Check-In."
      • Submit background information and observation about the child for Introductory Session only.
  • Clients 14 years and older need to submit the "New Client Questionnaire" and "Pre-Appointment check-in" forms.

(Select all that apply)
A

I understand the submission of forms by age procedure.

B

I understand that if I am a parent of a dependent child, I submit the Questionnaire and Check-Ins in addition to my child's submissions

C

I understand that dependent children 14 and older submit a Questionnaire and Check-Ins

D

I understand that if I am the Party Responsible for Payment for services for my married child or my child 25 or older, then I submit all forms including the Questionnaire, but do not submit Check-Ins.

Question 55 of 71

**Submitting all forms by all involved parties for first private sessions  48 hours before the appointment time is required so that I can review and prepare for the session, otherwise, time is spent on paperwork and not coaching.  Regular sessions have a 24-hour deadline for Check-Ins.  Please complete forms by the deadline, so they don't take priority over working with the client.  Extra time will not be added to the session to make up for the time used on paperwork.

(Select all that apply)
A

I understand the 48-hour submission deadline for all First Private Session Forms

B

I understand I need to submit Regular Session Check-In Forms 24 hours before my appointment

Question 56 of 71

Billing Procedure:

 

After booking your appointment, you will receive an email with a PayPal invoice along with the payment deadline.

 

NOTE:  The invoice email is not sent immediately after booking.  Remember, all payments are due at least 48 hours before your session time, so if you are booking a session 2-3 days in advance, select the "Pay now" option so that payment is received before the 48-hour deadline.  The invoice will come separately from your appointment confirmation.

    • Please complete before your 48-hour payment deadline.
    • To keep my bookkeeping straight, please pay from this specific email request rather than creating your own.
    • Any additional fees will also come through PayPal.

 

(Select all that apply)
A

I understand that my session(s) bill will come via separate email with a PayPal request

B

I understand that my payment is due at least 48 hours before my appointment time or before 48 hours of the first appointment in a multiple session package

C

I understand if I schedule an appointment 2-3 days in advance, to pay on time, I need to pay at the time of booking rather than wait for a PayPal invoice

Question 57 of 71

Coaching Packages:

 

"Mini" packages are available for those who would like private sessions on an ongoing basis and like the convenience of bundling payment.  These packages are designed to be used within a month.  No refunds are available, so please select these options only if you feel committed to completing a private session package within a month.



(Select all that apply)
A

I understand that multiple session packages are to be completed within a month and are not refundable

Question 58 of 71

Payment Policy:

 

  • The deadline for payment is 48 hours before your appointment time.
  • Failure to make payment by the deadline will incur a $20 late payment fee and can result in cancellation without notice.
  • Payment for services is the final step in confirming & reserving your appointment time.
    • If you miss your payment deadline, and another client is put into your slot, your appointment will be canceled without prior notice. You will receive an email notification that your appointment time has been canceled.
    • Please pay each fee from their specific email requests.
    • Both fees will need to be paid as soon as possible to avoid being eligible for cancellation and before the session can begin.
    • If a client in distress or has an emergency contacts me, I reserve the right to book them into a slot past its 48-hour payment reservation deadline.
    • If you miss your 48-hour payment deadline; there will be a $20 late payment fee (also sent via email) in addition to the session fee.
    • No extra time will be added to the session to handle payment issues that could have been addressed earlier.



(Select all that apply)
A

I understand that payment for service is the final step in reserving my appointment time

B

I understand and agree to a $20 late payment fee if I do not send payment 48 hours before the appointment time or before the first session in a multiple session package

C

I understand and agree to the condition that my appointment may be canceled and given to another if I do not pay by the 48-hour deadline

D

I understand and agree to all fees being paid before the session can begin

Question 59 of 71

Appointment Procedure:

 

Call Time:  Session appointments are done over the phone.  Phone calls are less distracting and often allow clients to express their emotions more freely. 

 

  • Clients contact me at the scheduled appointment time.
  • My phone is a landline and does not accept texts at this time.  Phone #: 801.772.0176

(Select all that apply)
A

I understand and agree with how appointment time is started

B

I understand that Peggy's phone number does NOT accept texts at this time

Question 60 of 71

What to Expect:

 

Private sessions are a combination of coaching, training, and Energy Psychology(EP).

 

EP is a collection of mind-body approaches for understanding and improving human functioning.

 

EP focuses on the relationship between thoughts, emotions, sensations, behaviors, and known bioenergy systems (such as meridians and the biofield).

 

I want you to feel comfortable and introduced to what to expect before our First Session.

 

If you haven't done so already, read the answers on my FAQ page, so you have a working knowledge of what I do, how I do it, the materials you need on hand, and the options available to you.  That way, we get the most out of our time together.  I will answer any additional questions you have during our First Session.

 

Click to go to FAQ page: https://www.peggynazer.com/faq-s *

(Select all that apply)
A

I have read FAQ's page and understand appointment procedures

B

I understand I will benefit from having printer paper and crayons on hand before the start of all sessions.

Question 61 of 71

Experience Inner Dynamics Coaching before beginning Private Sessions:

 

Peggy's coaching and concepts are powerful but not commonly understood, therefore, it is highly recommended that those who want to engage in private sessions listen to the free session of Inner Dynamics Group Coaching before attending the First Private Session.  This free session can be found here:

 

https://www.peggynazer.com/inner-dynamics-group-coaching

 

(Select all that apply)
A

I understand that listening and participating in the free Inner Dynamics Group Coaching will best prepare me for my first private session.

Question 62 of 71

Appointments for Dependent Children:

 

I do a combination of coaching and energy psychology in most sessions.

 

  • I often use a version of color therapy with clients of all ages, but particularly with children, so please have printer paper and crayons at hand before every session.
  • At least one parent is required to have two private sessions with me before I start working with a minor-aged child or a child who is not responsible for payment.  Children progress better and faster when parents know first hand what sessions are like.
  • After booking a first private session for themselves, Parents must fill out a New Client Questionnaire about themselves as the Client.  Submit the Questionnaire 48 hours before the Session.  Parents will complete at least two regular sessions for themselves before I begin work with the child.  We'll determine the best course of action for the child at that time.
  • Parents need to be available &/or present during sessions involving all minor children, and children not responsible for payment unless other arrangements are agreed upon by all parties.  Plan on being present for your child's first session and let them know you will be there but may not stay for the whole time if they don't want you there.
  • It is not unusual for children, including older teenagers and young adults, to want their parent(s) present for the entire first appointment.
  • Many children prefer their parent(s) to be present at all appointments.
  • There is a question on the Check-In for both the parent and the child 14 years of age and older.  This will help us to determine how the Session will proceed.
    • This is something for you to discuss together before the session, so you both are putting the same answer on your respective Check-Ins.

 

 **NOTE:  The Party responsible for payment is held responsible for all fees incurred.  To keep infractions of policy to a minimum and avoid additional fees, it is recommended that you go over these policies with your child and keep good communication with them about their schedules, the importance of keeping appointments, giving ample notice if needing to reschedule, submitting intake forms, etc.

 

(Select all that apply)
A

I will have paper and crayons already available before each session begins

B

I understand that if I would like Peggy to work with my minor-aged child or with an older child for whom I am paying, I must begin by doing the Introductory Session and the session thereafter for myself. When my child begins sessions will be determined after my first regular session.

C

I understand that I am expected to be present for my minor child's First Session and that my presence and/or availability will be determined for future appointments during that time

D

I understand that my child, regardless of age, may prefer that I be present for all their appointments

E

I understand and agree that as the party responsible for payment, I am held responsible for the child's violation of any procedure or policy and the payment of the associated fees and fines.

Question 63 of 71

Additional Appointments may be needed for parent(s):

 

Parents are leaders.  As long as a child is living in your home or subject to your authority, they follow your lead.  Sometimes for a child to move forward, a parent needs to engage in more than just the first two appointments.  I love working with children!  However, be prepared for the possibility that you may have more appointments in your future to help your child shift.  Children subject to their parents cannot go past them until they've left home.  Parents do not always have to do more appointments after the initial two, but I find it a good practice to clarify it as a possibility.



(Select all that apply)
A

I understand that if I have a child doing appointments, I may need to do more appointments myself after the initial two sessions

B

I agree to complete additional sessions for myself if Peggy recommends them to be necessary.

Question 64 of 71

Rescheduling and Cancelling Procedure:

 

  • Up to 48 hours before your appointment time, you have the ability to cancel and reschedule your appointment yourself via the confirmation email you received at the time of booking.
  • This convenience is available 24/7.
  • It is the preferred method for schedule changes and will be the quickest way to adjust your schedule.
  • This saves us both time.
    • You don't have to play email/phone tag with me.
    • You can make sure you get it completed before the 48-hour deadline.

 

**Rescheduling and Cancellation requests after the 48-hour deadline must be sent to email:  [email protected]

 

(Select all that apply)
A

I understand where to go to cancel or reschedule my appointment

B

I understand that after the 48-hour deadline, this option is not available

C

I understand that after the 48-hour deadline, I send a scheduling request email to: [email protected]

Question 65 of 71

Rescheduling Policy:

 

Every effort is made to help clients juggle unexpected changes in their schedules.  Please be very conscious of the fact that the nature of these appointments can sometimes challenge you to keep your appointment time.  Often the times you want to reschedule are the very times you need to continue forward and remove the block in your way.

 

  • You may cancel, reschedule and send a message to me via the confirmation email you received after booking your appointment.
  • You may reschedule yourself anytime before the 48-hour deadline.
  • If you reschedule before the 48-hour deadline, then full payment will be credited to your next scheduled appointment.
  • In the event of an emergency after the 48-hour deadline, the system will not let you make changes.  Reschedule by sending an email to [email protected]
  • Multiple needs to reschedule after the 48-hour deadline will incur a $75 rescheduling fee.  The fee will be sent via email and is due before the rescheduled appointment time.



(Select all that apply)
A

I understand I may reschedule before the 48-hour deadline with full payment moved to my new appointment time

B

I understand that after the 48-hour deadline, I send a scheduling request email to [email protected]

C

I understand that requests after the 48-hour deadline should be sporadic, and if late requests become common, a $75 rescheduling fee will be charged

Question 66 of 71

Cancellation Policy:

 

Sometimes people are tempted to cancel, instead of rescheduling, an appointment.  Please be very conscious that the nature of these appointments can sometimes challenge you to keep your appointment time.  Often the times you want to cancel are the very times you need to continue forward and remove the block in your way.

 

  • There is a 48-hour cancellation, rescheduling, and payment policy to allow time to fill and reserve your slot.
  • Payment for services is part of reserving your appointment.
  • The deadline for payment is 48 hours before your appointment time.
  • Failure to make payment by the deadline can result in cancellation without notice.

 

The following are situations regarding Cancellation, WITHOUT rescheduling.

 

  • If you cancel before the 48-hour deadline without rescheduling, then a full refund will be issued minus a $10 booking fee.
  • No refund will be issued if you miss your appointment or cancel with less than 48 hours' notice .
  • If you miss your appointment or cancel with less than 48 hours' notice and have not made the payment, you are still responsible for paying your session fee plus a $40 cancellation fee.
  • If you miss your appointment, have not made the payment, and did not contact me to cancel, you are still responsible for paying your session fee plus a $75 no-show fee.
  • Fees need to be paid before you book another appointment.
  • For cancellations after the 48-hour deadline, send an email to [email protected].

 

**Fees need to be paid before you book another appointment.  If you cancel, resetting your account may be necessary.  Before booking a new appointment using the online calendar, please send a new booking request to [email protected].

 

(Select all that apply)
A

I have read, understand, and agree to the Cancellation Policy and its associated fees

B

I understand that cancellations after the 48-hour deadline require an email sent to [email protected]

C

I understand that if I cancel an appointment and wish to book another session later, I need to send a new booking request to [email protected]

Question 67 of 71

Clients 18 years and older are required to complete all Intake Forms.  In addition, parents of Minor Clients AND the Party Responsible for Payment of Services are also required to complete all Intake Forms.  Submit separate forms where necessary so that all documents are received from all required parties.

 

These First Private Session forms are due at a minimum of 48-hours before the session.  If documents are not received, then completing these forms will be the priority in the session.  No extra time will be allotted to the session to make up for time spent on forms.

 

(Select all that apply)
A

I understand that these Intake Forms must be submitted by clients 18 years and older, by parents of minor clients, AND by the party responsible for payment. Failure to fill out all fields and submit this form by all parties involved 48 hours before the session will prioritize completing and submitting all necessary forms. No extra time will be allotted to the session to make up for time spent on forms.

Question 68 of 71

Another limitation of this form's platform is that there is no "back" button; however, after submitting this document, you will be able to see your results.  Please review all personal information to make sure it is correct and complete.  If you missed or misspelled anything, please correct it and resubmit.  Your missing or inaccurate information can result in your withdrawal from enrollment without a refund.

 

(Select all that apply)
A

I understand that all information on this form must be correct and complete.

B

I understand that missing or inaccurate information can result in my withdrawal from enrollment without a refund.

C

I understand that I can review my information on the forms after submitting them. I can resubmit corrected documents if necessary.

Question 69 of 71

You certify that you have read, understand, and agree to all the policies and procedures for Peggy Nazer Coaching.  Your submission of this form serves as your electronic signature.

(Select all that apply)
A

I certify I have read, understand, and agree to the Policies and Procedures for Peggy Nazer Coaching. I understand that my submitting this form serves as my electronic signature.

Question 70 of 71

Please state, using the exact phrases written in bold, the position that describes you best:

 

#1  The Client - Party Responsible for Payment (You or your spouse pays for enrollment.)

 

#2  The Client - Not Responsible for Payment (This answer typically applies when the client's enrollment is paid for by a parent/guardian. NOTE:  client's under 18 do not fill out this form.

 

#3  The Parent/Guardian - Party Responsible for Payment

 

#4  Party Responsible for Payment - Not Guardian (This answer typically applies if another relative, a friend, or clergy is paying for the client's enrollment.)

 

After reading through the descriptions above, the position that describes me best is:

Question 71 of 71

Type Your Name As It Would Appear on a Signed Document:

Confirm and Submit