Skype or Phone Session Application Form

Give the gift of healing to yourself or a loved one. We are now offering One-to-One Skype or Phone Sessions. This is an opportunity to book a 50 minute appointment with one of our therapists.

Please select the session you are interested in. Once you purchase the session(s), we will send intake documents for you to complete and submit. Arrangement will be made for one of our coaches to connect with you.

If you have any questions, please email us at info@pvhealing.com.

Pricing is in Canadian dollars. For Non-Canadian Residents, all pricing is in US dollars.

Skype or Phone Session Packages Available:*

1 Session - $165 CDN (US dollars if not in Canada) 5 Sessions - $750 CDN (US dollars if not in Canada)

Costs are subject to 5% GST

Name*

First Name

Last Name

Email*

Date of Birth*

Phone Number*

Alternate Phone Number

Gender*

Female Male Transgender

Other:

Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Is your billing address same as your current address?*

Yes No

Billing Address

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Name on Card*

First Name

Last Name

Card Type*

Visa Mastercard

Credit Card*

Number of Units (for Application Fee)

Total Payable CA$

I understand that should circumstances prevent me from keeping an appointment, a minimum 24 hours notice is required for any change. I understand all fees are non-refundable and should I miss a session without providing required notice I understand no credit for the missed session will be provided.