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Booking Intake Form 

Preferred Method of Contact
Phone
Text
Email
Type of Session You're Interested In
Preferred Date and Time for the Session
:
Alternate Date and Time
:
Have you ever had a coaching session or Reconnective energy session before?
Yes
No
What areas of your life are you looking to improve or focus on? (Check all that apply)
How did you hear about us?
I understand that the information provided will be kept confidential and used solely for the purpose of this session.
Yes
No
I agree to the terms and conditions of booking a session with Regina at Ideal Alignment Inc.
Yes
No

Thank you for filling out this intake form. We are excited to work with you on your journey towards ideal alignment and balance. Please click the & 'Submit" button below to complete your booking request. We will contact you shortly to confirm your session details.

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