New Client Form

Please complete this form, so I can maintain your information. Your session is not booked without the collection of your session fee.

Name
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Cell Phone*
Email*
Child #1 Name and birth year
Child #2 Name and birth year
Child #3 Name and birth year
Spouse name and any other children
Do any of your children have special needs?
- Yes
- No
If yes, please describe your child's diagnosis or special needs.
How did you hear about me? (Web search, magazine, friend, etc). If you heard of me through someone, please provide their name, so they receive their bonus.
Session fees must be paid in order to hold your session. You will pay your session fee via:
- Zelle (use 630.585.7959)
- Pay online (a payment link will be sent via email within 48 hours)