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BOLD Life Wellness and Consulting 
National Coaching Services

Intake/Agreement Form

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 Credit Card Information

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CONSENT:  Courtesy Cancellation Fee/No Show Fee (client fails to honor appointment within 24 hours of the date of service) - $15

Signature Line:  I agree to the terms and conditions as stated above. I also authorized BOLD Life Wellness and Consulting LLC to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account

Thanks for registering.

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