Please take a few minutes to fill out and submit this form.
*** Please take a few minutes to read this to avoid misunderstandings about payment. Payment is always expected and required at the time of your visit. The fee is $120.00 per session and the length of each session is 90 minutes.
You may pay by Cash OR Cheque.
Cheques returned by your bank are subject to a $42.50 processing charge.
If you are not able to keep a scheduled appointment and do not give at least 24 hours notice or fail to show up for your scheduled appointment, you are subject to being charged for the missed appointment.
Please be assured that All Information provided to Lorraine Kettle will be kept strictly confidential.
Throughout the clearing relationship, Lorraine will engage in direct and personal conversations. You can count on Lorraine to be honest and straightforward in asking questions and making requests. You must understand that the power of the clearing relationship can only be granted by you, and to the degree that you agree to do that, will be the degree to which we keep the clearing relationship powerful. If for any reason you believe the session is not working as desired by you, it is your responsibility to communicate this, to speak your truth. We can then take actions to return the power to the clearing relationship.
Your signature on this agreement indicates full understanding of, and agreement with, the information provided on this document.
I would like to take this opportunity to welcome you and assure you that I will do my utmost to provide the best service possible.
By clicking the SUBMIT FORM button you agree that You have read and understand the Financial & Confidentiality Policy.
