Payment *

First Name

Last Name

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Marital Status *

Single

Married

Divorced

Widow

What type of coaching are you interested in? *

Christian Life Coaching

Christian Stress and Trauma Recovery Coaching

Pre-Marital Counseling

Marriage Counseling

What type of relationship do you have with Jesus Christ? *

Not Sure

Not Interested

No relationship

No relationship, but I want to learn more about Jesus

I have accepted Jesus Christ as Lord and Savior

All coaching services and communication email or otherwise, delivered by V31 Woman Ministries as well as information on this website V31Woman.com are meant to help you identify the areas in your life and in your thinking that may be standing in your way. However, coaching is not professional mental health care or medical care. If you feel psychologically stressed to the point that it is interfering with your ability to focus, please have the courage to seek the help you need in the form of a professional therapist. In that spirit, by purchasing coaching services from your Coach, you confirm that you have read and agreed to each statement and that you wish to proceed:

Agree

Disagree

I understand that the coaching services I will be receiving from V31 Woman Ministries are not offered as a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that V31 Woman Ministries is not acting as a mental health counselor or a medical professional.

Agree

Disagree

I understand that V31 Woman Ministries is, at present, an unregulated industry and that V31 Woman Ministries is not licensed by any internationally recognized therapy regulator. I also understand that for all legal purposes, the services provided by V31 Woman Ministries will be considered to be provided from any remote location worldwide.

Agree

Disagree

I understand and agree that I am fully responsible for my well-being during my coaching sessions, and subsequently, including my choices and decisions even if suggestions are made by V31 Woman Ministries. I agree that I will exercise my free will during all sessions and communications with V31 Woman Ministries and cannot hold them responsibile for any outcome. All decisions are made by me, the client.

Agree

Disagree

Agree

I understand that V31 Woman Ministries will not share any information about sessions or communication with anyone other than me, the client.

Agree

Disagree

I understand that the coaching services provided to me, by V31 Woman Ministries is Bible-based and will refer to God, Jesus Christ, and the Holy Spirit throughout the coaching process. *

Agree

Disagree

I understand that payment is due immediately when scheduling appointments/sessions. A full refund is only available if I, the client, send a written request by email for a full refund within 24 hours of booking my appointment/session. Thereafter, all payments are non-refundable. *

Agree

Disagree

I have read and agree with the above terms and policies listed by V31 Woman Ministries *

Agree

Name *

First Name

Last Name