Life Force Connection

Intuitive Success Coaching Certification Student In-Take Form

Full Name (Last, Middle First): / Today’s Date:
Street Address (must match credit card): / Email:
City, State Zip Code: / Intuitive Success Coaching Cert. Start Date:
Contact Phone: / Date of Birth: / Payment Method:
Cash Check Credit Card
Credit Card #: / CVV#: / Exp. Date: / Program Amount/Arrangement:
$3,000 Early, $5,000 Reg. (circle one)
Payment Arrangement Details:
Visa Mastercard / Discover (check one)
Please briefly describe your current issue or any concerns that you have.
What do you hope to achieve from our time together?
Have you ever receive or are currently seeing a physician or therapist for any physical or psychological conditions? If so what is/was your experience?
What do you expect in a teacher?
How can we best support you?
Do you have any special needs? If so please describe below whether they are physical, emotional or psychological:
VISION & INTENTIONS:
Rate the following areas from one to ten currently based on the fulfillment you are experiencing now. Then write your future visions and intentions as you would like them:
Feel free to answer on a separate sheet of paper.
A. Career and Finances: (1-10) Explain your current situation:
Ideal/Future Situation:
B. Health and Wellness: (1-10) Explain your current situation:
Ideal/Future Situation:
C. Relationships (to self and others): (1-10) Explain your current situation:
Ideal/Future Situation:
D. Fun and Recreation: (1-10) Explain your current situation:
Ideal/Future Situation:
E. Personal Life: (1-10) Explain your current situation:
Ideal/Future Situation:
What frustrates you or stops you from having what you want now?
How would you feel if you already had your dream/vision?

I understand that all services provided by Life Force Connection are limited to the scope of practice that includes alternative healing modalities in the forms of Reiki, Intuitive Success Coaching, Neuro-Linguistic Programming, and Hypnotherapy. Abigail (Abby) Gooch has been certified as a: Certified Health and Success Coach; Reiki Master; Certified Master NLP Practitioner; Hypnotherapist, Six Sensory Professional Practitioner, Certified Spiritual Healer, Intuitive Success Coach, Intuitive Practitioner and Ordained Minister.

I understand that the nature of this work is organic and may trigger deep seated emotions, beliefs and thought patterns that may not have been questioned before. I acknowledge the responsibility for my results and do not hold Life Force Connection responsible in any way.

I understand that the processes taught and coaching sessions are guidelines and may vary from person to person. I am committed fully to the process and will do my best to fully participate and engage in all exercises and requirements for the coaching session or program/course I have enrolled in. I understand that the more I commit and engage in the process, the more I will get. Results may be seen before, during and after session/coaching program.

I understand that I am responsible for the full payment of my session or program and that there are NO REFUNDS. I agree to complete my payment arrangement if it has not be paid off after I have received my service and regardless of if I have chosen to not complete the program. I authorize Life Force Connection to charge my credit card for the fees based on the service I have signed up for as listed above unless I pay by cash or check.

I do not hold Life Force Connection liability for any health concerns or related issues. I understand that Life Force Connection can refuse to work with me and/or terminate the session/program at any time. I also understand that coaching sessions/or programs may be re-scheduled at any time and there is a 24hr cancelation policy for all appointments missed to avoid full service fee or forfeiting of the session (s).

I, ______, hereby acknowledge that I have been provided with above information, have read such, and agree to these terms.

Signature / Today’s Date

My Commitment To You:

I will show up on-time and deliver the Intuitive Success Coaching Certification curriculum composed of the Intuitive Factor, NLP Factor, Business Factor, Reiki and Integration sections (Yoga, Meditation, Expressive Dance) during class hours.

All information is confidential.

During our time together I will hold a space of unconditional love and non-judgment.
My role is to support you. I will intuitively guide you to make the changes you are asking for and encourage you to do the work. I will hold the highest vision of you I see and will continually guide you to trust yourself.

I am not responsible for your results.

I know your results are up to you and there is an infinite capacity to be more of who you are and achieve your goals in the appropriate time. This program can serve as a catalyst for you to be more of who you are.

I see you.

As your teacher I see the best in you and help you to reveal your gifts and ability to consciously create the life you love. I will help you to release blocks and limitations held at the mental-emotional level to free up your energy for greater outcome achievement whether your goals are to improve your health, relationships, finances and/or career.

I trust you.

Intuitive Success Coaching was founded on the principle that all the answers we need are within us. I trust that this process will lead you to the discovery of your own answers, self-love and personal empowerment!

Intuitive Success Coaching is a process that takes you deeper into your own inner knowing to discover the healing principles of transformation and the Universal Laws of energy to create a life you love.

Signed: ______Date: ______
Abby E. Gooch

Coaching:

Intuitive Success Coaching Session 1 hour/$200

Miracle of U Coaching Program 3-Month Series $1,500 in full or $597/month
(Includes 1 hour session per week plus online Miracle of U audio and workbook)

Classes:

Chakra Yoga $10-$15 Suggested Donation

Chakra Classes $35/class or $200/7-class series
(available in person and online)

Workshops:

Intuitive Workshops $595/weekend

Certifications:

Reiki Certification $300/Level 1, $500 Level 1 & 2

Intuitive Success Coaching Certification Program
(200 hours including class time, practice coaching sessions and integration of Yoga, meditation and expressive dance)
$3,000 Early Registration (1-month prior)
$5,000 Regular Registration
Payment Options of $300-$500/month at 10% interest

Schedule at: http://lifeforceconnection.com/schedule.htm