Mentoring Intake Form

Mentoring Client Intake Form

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Which of the following best describes your interest in Mentoring? (check all that apply) *

Please share more about what is drawing you towards Mentoring. Is there something in particular you would like your session/s to focus on? Is there anything helpful for Amy to know in preparation for our session? *

I understand Mentoring sessions are not an equivalent to counseling or behavioral health sessions. Mentoring sessions are not designed to process traumas, life events, or replace psychological care. *

Yes, I understand.

Payment & Appointment Information

Credit Card Number *

CVV *

Expiration (MM/YY) *

Zip Code *

Session cost of $70 is charged at time of making your reservation. 24 hour notice required to reschedule. No refunds or cancellations.

Selection for Session Date/Time *

I give Latitude 44 Yoga Studio permission to charge my credit card and reserve my non-refundable appointment time. *

Yes, please schedule my appointment.

Submit