Please complete this form to request your reservation.

**By sending this form you agree to the following statements:

1) I understand that coaching does not involve the diagnosis or treatment of disorders as defined by the American Psychiatric Association. I understand that the coaching services I will be receiving from my Coach 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 my Coach is not acting as a mental health counselor or a medical professional.

2) As a client, I understand and agree that I am fully responsible for my physical, mental and emotional well-being during sessions, including my choices and decisions. I am aware that I can choose to discontinue coaching at any time.

3) I understand that “coaching” is a professional-client relationship I have with my coach that is designed to facilitate the creation/ development of personal, professional or financial goals and to develop and carry out a strategy/plan for achieving those goals.

4) I understand that my Coach will protect my information as confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken and my confidentiality agreement limited in this capacity. Furthermore, if my Coach is ordered by a court to provide information or to testify, they will do so to the extent of what the law requires.

 If you have any questions please contact us at

or call us 613 – 930-5152

Grief is an unknown part of life we witness… and feel… 

Grief is real and grief is pain… 

Grief hits the bottom of our gut and center chest.

Look into my eye and I will help you heal.