Name *

(only those that have signed the original contract can sign the cancellation notice)

First Name

Last Name

Original Session Date: 9/14/2024 *

Yes, this is correct

As per your contract signed on 8/26/2024 your retainer is non-refundable. Please check your contract with any questions you may have regarding this. *

Please select ONE of the options below.

Yes, I understand and agree.

OPTION 1 ► I would like to RESCHEDULE my session for a later date. I understand that this offer will expire on 9/14/2026. ◄

I would like to RESCHEDULE

OPTION 2 ► I would like to CANCEL my contract and apply my retainer towards a future session. I understand that this offer EXPIRES on 9/14/2027

I would like a DISCOUNT

OPTION 3 ► I would like to CANCEL my contract completely.

I would like to CANCEL

Client's Signature *

First Name

Last Name

Date

MM

DD

YYYY