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The Successful
Life Foundation |
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YOUR INDIVIDUALIZED PROGRAM
FOR FURTHER INFORMATION:0208 550 4122 UK/585 394-4143 USA jayne_chilkes@yahoo.co.uk What people say: Very beneficial - I feel a sense of calm now, which I am trying to pass to others - Lynda McKay Some great tips for fast relief. Great stuff .more please! - James Chinery Loved it - very relaxed and calm. Need it every week! - N.Cawthorne For us to maximize our time together I have enclosed a brief questionnaire and details which will assist us in the first session to:
The investment for this 4 week program will be $199 payable in full on the your first session. This includes: 1st week Consultation, what you want to achieve and setting up a plan for the next sessions and interim exercises 2nd week Working to your individual plan 3rd week Working to your individual plan 4th week Continuing work, revising and evaluating your progress Please confirm the dates by telephone. Cancellation given within 48 hours are acceptable and appointments can be reorganized. There are no refunds available. I look forward to working with you and assisting you in your Self Development. CONSULTATION QUESTIONNAIRE - STRICTLY CONFIDENTIAL Full Name/Sex . Age . Address Married .. ..Children .. Telephone/Email/Mobile .................................................................................................................. Occupation .................................................................... Are you currently taking any medication? .. Have you ever had psychiatric treatment? .. Have you any physical/medical conditions? Have you recently gained or lost weight? ... Have you recently consulted your doctor? . Tick
any areas that indicate a problem/challenge to you:
Other reasons for visiting: ........................................................................................................... What are the desired outcomes from your Program of Growth: ........................................................................................................... Preferable days and times for weekly visits: Your signature ..Date . My signature ..Date VENUE:London or S. Bristol, NY see mapquest.com
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