Welcome to United Inner States of Freedom and congratulations on choosing a Life Coaching session for your growth and healing.

Let's get you started by signing a few forms and booking your session date and time.

Click next to begin the process.

Let's take this first step together!

First Name *

Last Name *

Email *

Phone *

I Consent to Receive SMS Notifications, Alerts Communication about my appointment from United Inner States of Freedom Inc. - we will not use your information for marketing purposes.

Life & Executive Coaching is NOT psychotherapy, nor counseling. It is a philosophical and educational approach, not psychological, to improving well-being. The term coaching as mentioned, does not refer to psychological state licensed professional, psychiatric, or clinical medical advice. There is no diagnosis established and your health insurance will NOT cover your meetings/coaching sessions. If you choose to discuss your personal issue and commit to coaching, you are responsible for your own well-being. *

I agree

I acknowledge that coaching and the healing tools offered in all types of sessions by United Inner States of Freedom Inc. are not a substitute for psychiatric and psychological treatments and that I am responsible for continuing any of these treatments prescribed by my psychologist, psychiatrist, or medical doctor and that in case of emergency, I will go to a hospital ER. *

I agree

No records kept would be of any value in legal proceedings, nor would our impressions be of value to other health professionals or mental health professionals. Pascal & Alexandra Renders will not provide written or verbal reports to attorneys, health professionals, mental health professionals, health insurance companies, or anyone else. *

I agree

Pascal & Alexandra Renders are NOT Medicare providers, and you will not be reimbursed by Medicare or any health insurance. *

I agree

All interventions designed to address emotional and behavioral issues come with some degree of risk, and results cannot be guaranteed. *

I agree

Pascal & Alexandra Renders will not be providing medical or legal advice, psychotherapy, psychology, social work, or counseling. Life & Executive Coaching provides a philosophical and educational approach to maximizing mental and emotional well-being. *

I agree

Sessions may be video or audio recorded. *

I agree

I acknowledge that I have read, understand and agree with the statements above.

Printed Name *

Signature *

Clear

Date *

Please click submit to complete the disclaimer and informed consent form.