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Client Information
Name:
Address:
Date of birth:
Cell phone:
Email:
Current place of study:
Program of study:
Relationship
Phone #
In order to enable progress and success, it is crucial for clients to commit to regular weekly
attendance for the duration of their academic semester. Clients are also expected to arrive on time to
their sessions; please note that sessions cannot be extended to accommodate late arrivals.
CANCELLATIONS
Notice of 24 hours must be provided for cancellations, unless you are sick or there is an emergency. In
these rare cases, please let us know about the cancellation as soon as possible by emailing
robin@brightsidelearning.com or calling 514-242-5162. Additionally, if less than 24 hours notice is
provided, you are responsible to pay an administrative fee of $35.00 that is due at the beginning of
your next session. Please note that if frequent cancellations are recorded, a re-evaluation of your
commitment to coaching and discussion about your weekly time slot will ensue.
PAYMENTS FOR SESSIONS
The cost of the Initial Consultation is $85.00 and payment is accepted at the end of the session.
The cost of the 30-minute weekly session is $40.00 and the cost of the 50-minute weekly session
is $65.00; payment is due at the beginning of the session.
Insurance receipts for naturopath services are provided upon payment; please contact your
insurance provider to verify your eligibility.
Accepted methods of payment are cash, cheque or credit card (Visa, MasterCard or Amex)
All cheques should be made out to Brightside Learning; please note that insufficient funds for
cheques (NSF) will incur a $15.00 administrative fee and all future sessions will be suspended
until the payment has been rectified.
I have read Brightside Learnings Coaching Agreement and agree to its terms.
Date: ___________________________________
173 Cartier #103, Pointe-Claire, Quebec H9S 4R9 | 514-242-5162 | robin@brightsidelearning.com |www.brightsidelearning.com