Skip to Content
ericabreenwellness@gmail.com
Looking for Something?
Erica Breen Wellness
Transforming Bodies & Minds, Globally
Home
About
Work with Me
Virtual Wellness Sessions
Mentorship
Workshops
Customized Nutrition Sessions
International Traveling Instructor
Testimonials
Products
Blog
Shop
Contact
Erica Breen Wellness
Transforming Bodies & Minds, Globally
Home
About
Work with Me
Virtual Wellness Sessions
Mentorship
Workshops
Customized Nutrition Sessions
International Traveling Instructor
Testimonials
Products
Blog
Shop
Contact
Wellness Consults Intake Form
Name
(Required)
First
Last
Email
(Required)
City
Country
Birthday
MM slash DD slash YYYY
Whatsapp Number
Health Concerns (one per line)
(Required)
What are your health goals?
(Required)
Medications or nutritional supplements you are currently taking
(Required)
Liability Waiver
RELEASE OF LIABILITY FOR PERSONAL OR ONLINE NUTRITION SESSIONS WITH ERICA BREEN
Wellness Consults with Erica Breen
is not a replacement for Medical, Psychological or Psychiatric care.
Erica Breen offers Nutritional and Wellness Coaching to help you find a healthy balance in your life. However, you are responsible for your health and must determine whether Erica Breen is the correct person for you and your needs. If at any time you are unhappy with the results of your session(s), you should discuss this with Erica Breen and/or seek alternative Counseling.
By submitting this form, you are agreeing to release Erica Breen from any liability, legal or otherwise, for the outcome of the coaching sessions, or decisions you make as a result of them. Only if you are willing to take full responsibility for yourself and your own decisions, should you accept coaching sessions from Erica Breen.
No refunds will be given.
Consent
(Required)
Policies:
♦ All sessions are 60 minutes. Sessions will begin and end promptly as scheduled.
♦ Regardless of arrival time, sessions will end at the scheduled time.
♦ 24-hour notice of cancellation is required to avoid being charged for sessions. Cancellations can be done via email. (ericabreenwellness@gmail.com)
♦ Late cancellations and no-shows will be charged the full amount of the scheduled session.
♦ Payment must be received 24 hours prior to scheduled session. If not received the session will be cancelled.
♦ All purchases are non-refundable.
I HAVE READ THE ABOVE POLICIES AND FULLY UNDERSTAND THEIR CONTENTS. I VOLUNTARILY AGREE TO THE TERMS AND CONDITIONS STATED ABOVE.
Date of Submission
(Required)
MM slash DD slash YYYY
CAPTCHA