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Discovery Call Intake Form
First Name
Last Name
Email
Phone
What's your primary reason for seeking coaching?
Have you received coaching or counseling before?
I, _________________________, acknowledge that PresenceU team members have voluntarily agreed to meet with me to support my pursuit of healthier relationships. I understand this is not professional counseling, and team members are not licensed therapists. Their guidance is offered to the best of their ability within the scope of their training. I voluntarily seek assistance and am under no obligation to accept or follow any advice given. I understand that my disclosed information may be shared with PresenceU leadership or spiritual mentors as necessary for my personal and spiritual growth. I acknowledge that PresenceU team members are mandated reporters under California law and must report: Any expressed intent to harm oneself or others. Any known or suspected child, elder, or dependent adult abuse, per California Penal Code ยงยง 11164-11174.3 and Welfare & Institutions Code ยง 15630. I release and hold harmless PresenceU, its team members, and affiliates from any liability, claims, or damages arising from the assistance provided. I assume full responsibility for my choices and actions.
I have read and agree to the terms above.
Applicant's Name (Must be signed by the applicant or a legal guardian if the applicant is a minor under the age of 18).
I have read and agree to the terms following. I, _________________________, acknowledge that PresenceU team members have voluntarily agreed to meet with me to support my pursuit of healthier relationships. I understand this is not professional counseling, and team members are not licensed therapists. Their guidance is offered to the best of their ability within the scope of their training. I voluntarily seek assistance and am under no obligation to accept or follow any advice given. I understand that my disclosed information may be shared with PresenceU leadership or spiritual mentors as necessary for my personal and spiritual growth. I acknowledge that PresenceU team members are mandated reporters under California law and must report: Any expressed intent to harm oneself or others. Any known or suspected child, elder, or dependent adult abuse, per California Penal Code ยงยง 11164-11174.3 and Welfare & Institutions Code ยง 15630. I release and hold harmless PresenceU, its team members, and affiliates from any liability, claims, or damages arising from the assistance provided. I assume full responsibility for my choices and actions.
I, _________________________, acknowledge that PresenceU team members have voluntarily agreed to meet with me to support my pursuit of healthier relationships. I understand this is not professional counseling, and team members are not licensed therapists. Their guidance is offered to the best of their ability within the scope of their training. I voluntarily seek assistance and am under no obligation to accept or follow any advice given. I understand that my disclosed information may be shared with PresenceU leadership or spiritual mentors as necessary for my personal and spiritual growth. I acknowledge that PresenceU team members are mandated reporters under California law and must report: Any expressed intent to harm oneself or others. Any known or suspected child, elder, or dependent adult abuse, per California Penal Code ยงยง 11164-11174.3 and Welfare & Institutions Code ยง 15630. I release and hold harmless PresenceU, its team members, and affiliates from any liability, claims, or damages arising from the assistance provided. I assume full responsibility for my choices and actions.
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