Coaching Request Form

Please note, this coaching is provided voluntarily and free of charge by an experienced wellness coach. This is NOT medical care. The coach may choose to work with you via televideo or telephone. The number of sessions will be determined by you and the coach. By submitting this form you accept that neither the coach nor the sponsors of the Live! program and its affiliated organizations accept any liability. You are responsible for checking with our doctor before making any life changes that may impact your health.

Coaching Request

CONTACT

Address
Address
City
State/Province
Zip/Postal
Country

AVAILABILITY

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Please indicate whether you would like the coach to contact you by phone or email. *

By accepting this free voluntary coaching service, you the client agree that using any of these life coaching services are entirely at your own risk. Life coaching services are provided "as is", without warranty of any kind, either expressed or implied, including without limitation any warranty for information services, coaching, uninterrupted access, or products and services provided through or in connection with the service. This service is requested at the client's own choice and with inherent singular responsibility. Any actions or lack of actions, taken by the client of such advice is done so solely by choice and responsibility of the client and is neither the responsibility not liability of the coach the Live Long. Live Well. program or its sponsors. The client takes full responsibility in the decisions they make after being coached as well as the consequences. The client enters into coaching with full understanding that they are responsible for creating their own results. Periodically you may be provided links to other websites or written print material which may be of value, interest, and convenience to you. This does not constitute endorsement of material at those sites or any associated organization product or service. It is the responsibility of the user to make their own informed decision about the accuracy of those sites and print material including privacy policies.