mPEAK Coaching Intake Assessment

These questions are designed to make you stop and reflect so please take your time. If there is a question that you're having trouble answering, skip it and come back to it before you press submit. If you feel there are repetitive questions you can either go deeper or just refer to a previous answer. When complete, press "submit" and then review the paperwork, download the guided audio meditations and proceed to payment. Thank you for inviting me to be on this adventure with you.

Name *
Name
Address
Address
Phone
Phone

Paperwork

Please review the following documents. If you are engaging in virtual coaching, your verbal agreement is sufficient. 

Policies & Procedures

Client Agreement

guided meditation

Download the mPEAK guided audio meditations to your computer and device or find the meditations on the Insight Timer App.

Payment

All new clients must start with the Intake Session along with an eight session package. Additional coaching sessions can be purchased at any time. Below is a link to the online credit card option. However, if it's all the same to you, my preference would be a check which can be made out to me, Pete Kirchmer and sent to: 227 Neptune Ave., Encinitas, CA. 92024. 

Intake Session
300.00
Quantity:
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8 Coaching Sessions
1,200.00
Quantity:
Add To Cart