Vitruvian Square Energy Sculpting Application

Vitruvian Square Energetic Sculpting Application

First Name:

Last Name:

Where You Are Located:

Email:

Date of Birth:

Website

Tell me a little bit about yourself! (What problems are you dealing with? What things cause you stress? ):

What's the one thing you want in your life that you don't have now?

How have you tried to solve your problems in the past?

What are you willing to do to move from where you’re at today to where you want to go in the future?

What could you use more help with as far as achieving your desired outcomes?

If I could help you solve any problem, what would that be?

Additional background information that relates to your desire for a session:

Are you ready to take the next step and up-level your life forever?

YES

Message:

Required Waiver of Liability & Disclaimer: Because this training/coaching includes the use of what many consider to be divination tools it is, as required by law, offered for enlightenment, self-discovery, educational, and entertainment purposes only, is not experimentally proven, and is not meant or intended to be a form of advice, instruction, suggestion, counsel or factual statement in any way whatsoever. Divination cannot predict the future with certainty and you should not rely on a reading to make any decision that would affect any medical, psychological, psychiatric, business, financial or legal situation or condition. If your inquiry involves the law, business, finance, medicine, or mental health then you should seek the advice of a licensed or qualified professional. By obtaining this training you represent and are agreeing that you are 18 years of age or older and understand and accept that you are 100% responsible for any action taken based on interpretations, insights, and readings. You agree that this type of session is meant to provide guidelines and to help you better reflect upon yourself. By training/coaching/consulting with SJG, you and/or your representative(s) agree, except in the case of gross negligence or malpractice, to fully release and hold harmless SJG, its officers, employees, agents, directors, and related entities from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s). Only a training/coaching/consulting service is being provided. You accept any and all risks, foreseeable or unforeseeable, arising from such training/coaching/consulting services. You and/or your representative(s) agree that, except in the case of gross negligence or malpractice, SJG will not be held liable for any damages of any kind resulting or arising from, including but not limited to: direct, indirect, incidental, special, negligent, consequential, or exemplary damages happening from the use or misuse of SJG training/coaching/consulting services. You agree that use of SJG training/coaching/consulting services is at your own risk. By obtaining this type of session you release Scott Grossberg and Scott J. Grossberg, APC from any and all legal responsibility for your use of this service and its content. This service is provided "as is" with no guarantees. Finally, we know that the Internet allows you to read this anywhere in the world. This website has been designed to comply with United States laws. If anything on this site is contrary to the laws where you are located, then this content is not meant for you.

I AGREE

SIGNATURE (type your name)

DATE

Vitruvian Square Energetic Sculpting Application

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