Intake for: *

Rapid Transformation 1-1 Client Program ** 6-week

Rapid Transformation 1-1 Client Ultimate Program *** 8-week

Coaching

Costs 45 min video call intake 35 euro *

Checkbox the terms & conditions: I am aware that:

After the video call intake, I have 48 hrs to make the payment + schedule my 2-hour RTT session or coaching.

I get a 14-day (unless discussed otherwise, or payment plan time window to pick a date for my first session & second session of the program.

I'm aware that the 35 euro will not be refunded in case I don't book sessions.

Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Phone *

nr of ## indicates how much digits per box

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I hereby declare that I do not suffer from epilepsy, psychosis or schizophrenia and/or any other neurological conditions, *

I hereby declare

Checkbox *

Please check everything that applies to you

Addictions

Compulsive Behaviour

Drinking

Drugs

Gambling

Smoking

Anxiety

Fears

Guilt

Phobias

Panic Attacks

Relaxation

Stress

Anorexia

Bulimia

Eating Problems

Exercise

Food /Diet

Weight Problems

Achieving Goals

Confidence

Depression

Motivation

Procrastination

Self Esteem

Career Issues

Concentration

Driving Skills

Exams

Interview Skills

Memory

Nerves

Public Speaking

Childhood Problems Sleep Problems

Fertility

Relationships

Sexual Problems

I have read and accepted the terms presented in the Waiver *

I agree to the Waiver