Preparing for your PSYCH-K® Session

Let's begin by getting clarity on your goals.

All personal information is confidential and treated appropriately.

Click the button below to start.


Question 1 of 8

Please enter your contact information (name, email address, mobile #, address). 



Question 2 of 8

Select the areas of life where you may have challenges:

(Select all that apply)

Grief, loss and letting go of past pain


Self-esteem and self-love


Relationships - with self, others, job, career, substances, boundaries, giving and receiving


Spirituality and trusting the Universe


Personal power


Prosperity, abundance and money


Health and body



Question 3 of 8

Goals...What are the top three things you would like to address?

Question 4 of 8


What is missing from your life? What would make your life more fulfilling?

Question 5 of 8

What would you like to see occur during your lifetime in order for you to consider your life to have been satisfying and well lived?

Question 6 of 8

Feel free to share as much or as little of yourself and what brings you to a consulting/coaching session:

Question 7 of 8

Anything else you think would be helpful to know for our sessions?

Question 8 of 8

Welcome to consulting/coaching! I am excited to be joining you on this journey. I look forward to getting started. Below are a few housekeeping items. 

Consent Form

Please read and enter your name and date as your electronic signature below.


All information that we discuss is completely confidential and will never be shared by Agnes Chau LLC with anyone other than you, unless you authorize Agnes Chau LLC and its members to do so directly, and except where required by law.

Liability & Release

As the client, you understand that the services are consultative in nature and that decisions made and actions taken by the client are ultimately the complete decision and responsibility of the client. The consultant/coach shall have no liability or responsibility for any action taken or not taken by the client. 

Agnes Chau LLC will take reasonable precautions to help prevent risks, injuries, or exposures from occurring; however, Participant also understands and acknowledges that there are no warranties, assurances, or guarantees, express or implied, regarding the occurrence of any such risk, injury, or exposure to Participant while participating in any activity sponsored or conducted by Agnes Chau LLC. Participant’s decision to participate in any of Agnes Chau LLC's sessions, programs, courses, or events, is knowing and purely voluntary, and Participant, if Participant chooses to participate in an event or activity sponsored or conducted by Agnes Chau LLC, hereby knowingly and voluntarily assumes all risks of participation and waives all claims relating to risk, injury or exposure, as more fully set forth below.

Participant, individually or on behalf of his/her heirs and assigns, hereby fully releases and forever discharges Agnes Chau LLC, as well as each of its respective administrators, representatives, assigns, beneficiaries, agents, affiliates, employees, servants, officers, members, partners, predecessors, successors, insurers, attorneys, and any other related person or entity (collectively “Released Parties”), from all past, present, or future actions, causes of action, claims, controversies, costs, covenants, damages, demands, expenses, liabilities, losses, and suits for damages of whatsoever kind and nature, under any theory of recovery at law, by statute, in equity or otherwise, whether now known or unknown, and suspected or unsuspected, which have existed or may have existed, or which do exist, or which hereafter can, shall, or may exist, including, but not limited to, tort or contractual claims, economic or non-economic damages, compensatory or punitive damages, property damage, loss of use, investigatory costs, attorneys’ fees, expert costs and expenses, interest, or any other damages, whether caused or contributed to, in whole or in part, by the negligent or reckless conduct of the Released Parties, which in any way arise out of or relate to Participant’s knowing and voluntary participation in the services, programs, courses, events of Agnes Chau LLC.

Cancellations & Rescheduling

Cancellations and rescheduling must be done at least 24 hours prior to the session in order to get a credit. It is important for participants to attend appointments at the scheduled time. Missed or canceled appointments with less than 24 hours notice will not be refunded. 

Waiver & Release

By entering the name and date below, Participant warrants and represents that he/she has carefully read and understands this Release and that he/she has freely and voluntarily executed this Release without any coercion or duress. Participant has relied upon his/her own knowledge or, prior to signing, has consulted with or had an opportunity to consult with legal counsel of his/her choice concerning the legal consequences of signing this Release. Participant warrants and represents that he/she has not relied upon any advice, statement, or representation pertaining to this Release by Agnes Chau LLC in executing this Release. 

Enter name and date:

Confirm and Submit