Telephone Consultation Appointment Request Form (v 3.27)

American/British English must be your native tongue

Six steps to making a free appointment: (all six steps are free)

  • Do The Clearing Process — 5 clearings, 1 per day for 5 days in a row
  • Read definition of the word responsibility
  • Re-read about Consultations
  • Read the Agreements
  • Appointment Time
  • Submit Appointment Form

    • When making an appointment from other than Hawaii check here for the time in Hawaii.

    agreements

    Agreements:

    Read all the agreements before sending your Appointment Form.

    1) If I am doing the consult with another I agree that we will be sitting in separate rooms and not in view of each other. I will not record the conversation or allow anyone else to listen in on our conversation.

    2) If I am doing a telephone appointment with another I agree to have two corded phone instruments (no cell phones due to possible battery/connection failure).

    3) I understand that if I wish to have a conference call with my partner on another corded phone instrument (another phone in another room/location) that he/she must be on the line when I dial the coach (a conference call is typically made between the coach and two participants with everyone located at different residences).

    4) I agree to call on time. I understand that if I call late, by even one second, the appointment is canceled. I understand that keeping agreements is part of the value of the consultation.

    5) I understand that I may call up to ten minutes early for my appointment and ask to be put on hold until the appointment time, so as to ensure I am on time. (You might consider programming the coach's long distance number into your telephone before the appointment time so that all you have to do is push one button).

    6) If I need to cancel the appointment I agree to cancel 48 hours before the  appointment for which there is no fee. If I cancel in less than 48 hours before the appointment I understand that a $150 donation is suggested.

    7) I will ensure that there will be no interruptions (cancel call waiting, no baby-sitting, visitors, etc. —if appropriate I'll hang a "Do not knock until ____" sign outside my door).

    8) I understand I may announce a bathroom break at any time during the three hours.

    9) I will not attempt to do a consult with a child or baby in the house except that another can ensure zero interruptions for me.

    10) I have completed my five clearings.

    11) I have read the definition of the word responsibility.

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    time

    Appointment Time:

    In the Appointment Form below select three different days (Monday through Friday) that would work for you. You will be notified by email that one of your choices has been accepted.

    If during a consult you feel satisfied and are complete you don't have to stay on the phone for the full three-hours although the coach can always find new conversations (communication exercises/processes) of value.

    Once the coach has received your Consult Appointment Request Form you will receive an email that will include the 1-808 telephone number (Hawaii area code) to call, and, a confirmation of one of your three appointment times. The time slots for a free 3-hr consultation are Monday through Friday 9:00 am-12:00 noon and 1:00 noon-4:00 pm. (Evenings, weekends, or off-island consults = $150.00).

    When making an appointment from other than Hawaii check here for the time in Hawaii.

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     form
    form

    Appointment Request Form:

    * indicates a required field

    Please answer this question.*
          		   
    First Name*
          		   
    Last Name*
          		   
    Email Address*
          		   
    Confirm Email Address*
     
    Home phone*
          		   
    If winter is cold, summer is?*
    Spam-bot deterrence
         		   
    For Office Use Only. Do not put anything in this field.
          		 
    		 

    Enter your three preferred appointment times. #1 being your first preference.*

    For example:

    #1 Monday, October 8, 9:00am-12:00 noon
    #2 Tuesday, October 9,  9:00am-12:00 noon
    #3 Wednesday, October 10, 12:00 noon - 3:00pm

    		     

    Within a few hours (usually within 48 hrs) you will receive an email from me. Typically this is what the email will look like:

    Dear ____:

    I received your Consult Appointment Request Form. Thank you.

    Wednesday, October 10th, 1:00 noon - 4:00pm (Hawaii time) works for me.

    My phone number is (1-808-_______).

    The consultation is free however the suggested appointment late/cancellation donation is $150.00.

    Thank you,

    Kerry

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