Wellness Coaching Intake Form

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Wellness Coaching Intake Form - Fox Healing

Thank you for scheduling a Wellness Coaching session with Fox Healing. Please fill out the following confidential form to make our session together most efficient. If you have any questions, feel free to email fox@foxhealing.com.

Sessions are offered on a sliding scale from $150-$100. Please note that payment is due at the time of service via PayPal (Fox@foxhealing.com) or Venmo (@foxhealing). Cancellations made within 24 hours of the scheduled session time will be charged the full price of the appointment.

Virtual sessions are most effective and successful when you can find a private space free of interruptions. We recommend using a computer or a stable, hands-free setup with your phone. Avoid shifting backgrounds (fish-tanks, passing cars, etc) and mark your preferences in this intake form for choice of platform.

Feel free to check out some amazing resources prior to your appointment at https://www.foxhealing.com/resources

Email *

Full Name (Nickname in Parentheses) *

Email Address *

Physical Address *

Phone number *

Date of Birth *

Occupation/Life Focus

I identify my gender as:

Female

Male

Transgender / Non-binary

Other:

Clear selection

Emergency Contact Name *

Emergency Contact Phone Number *

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