Client Intake Form

ontact Us

Initial Session

Congratulations on your first step to shift your life! I am happy and delighted to be able to work with you. Please fill in the information below in preparation for your first session. Also, see below the payment options and some brief guidelines to keep in mind for each session. This form is confidential and your information will not be shared with third parties.

Name Given at Birth*

Full Name as it appears on your birth certificate. This is very important!

Date of Birth:*

Current Legal Name*

The name you currently use to introduce yourself or as it is on your driver's license, passport, etc.

Current Home Address*

Your current house or apt. number including letters.

Email Address*

Phone*

Current Situation*

Provide a brief explanation of your current situation, that you would like to ask about, change, improve, etc.

Introductory Question 1. *

Please answer the following questions. Explain as much as you need. 1. What do you want to ask or know about your current situation?

Question 2*

What specific concerns do you have that you want to clarify, validate or understand?

Question 3*

Which areas of your life would you like to work with: wellbeing, life partner, life purpose, family, career, finances, spirituality, etc. Explain why?

Question 4*

What do you expect from my services?

Your Questions

What are some of the questions that you would like to ask on your first session?

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ACCEPTED FORMS OF PAYMENT

VENMO

ID: @Lillie-Cintron

Phone: 727-365-3161

Email: [email protected]

CASHAPP

ID: $LillieCintronMBA

Phone: 727-365-3161

Email: [email protected]

ZELLE

Phone: 727-365-3161

Email: [email protected]

CANCELLATIONS POLICY

Appointments can be rescheduled with a minimum of 24 hours-notice at no charge.

Rescheduling within less than 24 hours-notice, for 3 or more consecutive times, will require a $35 rescheduling fee.

Cancellations require a 48 hours' notice for a full refund of fees, less a $75 cancellation fee for reports and prep-work done. Cancellations within less than 48 hours-notice will have a 50% refund of fees or $75 cancellation fee, whichever is higher.

No shows are non-refundable.