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Ready to Create Balance?
Complete this form and click submit to access online booking.
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First Name
Last Name
Date of Birth
Referred by
Cell Phone
Email Address
Street Address
City
Region/State/Province
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1. What would you like to accomplish and why? Be specific.
2. How would accomplishing your goals change your life?
3. In which areas of your wellbeing are you lacking balance?
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Required
Physical (Exercise, Nutrition, Rest)
Mental (Stress, Emotional, Cognitive, Coping)
Social (Relationships, Support Systems, Community)
Spiritual (Connection, Purpose, Mindfulness, Gratitude)
Financial (Security, Stability, Sustainability)
Intelectual (Personal Growth, Learning, Curiosity)
4. What challenges do you have with creating balance in your life?
*
Required
Stress Management
Maintaining Routines
Setting Boundaries
Practicing Self-Care
Maximizing Time
Achieving Goals
5. List any other challenges you have with creating balance in your life.
6. What brings you Peace & Happiness? What are you passionate about?
7. What's your occupation?
8. What's the best way to contact you?
If I cancel within less than 24 hours, or no show for my free consult call, I agree to pay a $59 cancelation fee.
I give consent to receive life balance consulting services from Zenlae, LLC. I assume full responsibility for services rendered and release the service provider and Zenlae, LLC from any liabilities or damages. I hereby hold harmless and indemnify the consultant, their principals, and agents from all claims and liability whatsoever.
Optional Photo Release: I grant Zenlae, LLC its representatives and employees the right to take photographs of me in connection with services received. I authorize Zenlae, LLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Zenlae, LLC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above.
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