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Intake Form for WIEH Coaching
Reduced rate Emotional Hygiene Coaching with EH Coach Practitioners-in-Training.
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First Name
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Last Name
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Affirming Pronouns (ex. she, he, they, etc)
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Email
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Phone Number (include country code)
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Location - street address
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Location - city, state/department, country, zip/postal code
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Emergency Contact - Name
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Emergency Contact - Phone (include country code)
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Any accessibility needs we can accommodate?
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How did you hear about the WIEH and our 1:1 Coaching?
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Would you like to receive news and updates about the Institute via our newsletter? Including info about classes, trainings, and discounts.
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Do you have any questions or comments for us? Anything else you'd like us to know?
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Dette skjemaet ble opprettet på Westfeldt Institute for Emotional Hygiene.
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