Spiritual & Life Direction Coaching Ministry Intake Form

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For those want to receive spiritual & life direction coaching ministry sessions with Wilson Cheh from www.pursuewholeness.com

This form will take you through a payment process at the end for your initial one or two sessions. You will be contacted by Wilson Cheh within 2 business days to schedule for the session time on payment is received.

Thank you!

Email *

First Name *

Last Name *

Birthday *

YYYY

Country & State *

Time Zone *

Phone number that we can call & text you *

Please briefly describe what other ministries you have prior engaged in, and what were the corresponding outcomes.
*

Requested Session Duration - Cost (in USD) *

1x Full 2 hour session - US$300

1x Regular 1.5 hour session - US$200

1x Mini 1.0 hour session - US$150

Other duration & agreed amount (please fill out the next question)

Other specific agreed amount - $

Who Will Pay? *

Myself

Someone Else

Emergency Contact: First & Last Name *

Emergency Contact: Relationship to You *

Emergency Contact: Phone Number *

Emergency Contact: Best way to contact (call/text) *

Are you currently receiving professional mental health services? *

Yes

Do you have any goals for our session(s) you'd like to share?
*

Is there anything else you'd like to share?

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