Session Request Form | Michael & Connie

How Can I Help?
Session Request Form

First name

Last name

Date of Birth

Phone

What would you like to talk about during our session?

I understand "How Can I Help?" sessions are scheduled based on availablility. Non-refundable payment due before each session.

I understand my participation in a "How Can I Help?" session is entirely of my own volition, and I am free to disregard any of the advice given. "How Can I Help?" sessions are not a replacement for professional counseling or therapy, and any advice, perspective, and/or suggestions given during or related to "How Can I Help?" sessions should be received in the spirit of general conversation and recommendations.

I understand "How Can I Help?" sessions are presented and conducted by Michael and Connie, LLC, and I hereby agree to indemnify and hold harmless Michael T. Smith, Connie M. Smith, and its officers, agents, employees, assigns, and/or volunteers.

I understand that due to scheduling and/or other conflicts and concerns, Michael and Connie, LLC reserves the right to refuse and/or discontinue any "How Can I Help?" session without cause. Refunds will be issued ONLY if we cancel/refuse service.

I understand "How Can I Help?" sessions are considered protected and confidential under "Clergy-Penitent Privilege" as defined, described, and excepted by U.S. and Georgia Law.

Signed

How Can I Help? Session Request Form

How Can I Help?
Session Request Form