Registration Form
Coaching, alcohol treatment and psychotherapy

The terms for personal process requires that you submit a minimum of information.
This is voluntary but required in order to be a participating client and all data are treated according to GDPR.
This is a necessity plus it saves time, costs and increases the quality of the work.
Process is based on mutual trust, honesty and confidentiality, the practitioner must know whom he is working with.
Your email etc. will not be shared with third parties without consent.

After sending the required* information, please take care of payment according to agreement.
You are committed to your booking request and the terms are legally valid and in force.
This form is a condition for consultation and failure/neglect/delay does not cancel your economic obligation.
Changes/cancellation later than 09:00 two work days before appointment is no matter reason charged at 100%.


Name and surname:*
Complete address:*
City and code:*
Personal email:*
Job and education:*


Partners name and surname:*
Partners complete address:*
Partners city and code:*
Partners personal email:*
Partners mobile:*
Partners nationality:*
Partners age:*
Partners job and education:*

Time slot

Other participants

Other participants:


E.g. message (not required):

Check the form (*required) before sending.
And await the receipt, which you can print.

English - by submitting this form, we again declare that we understand and accept below and the terms on the homepage:
In case of delay/failure in the submission of the form, the practitioner reserve the right to reject the client/dispose otherwise of the time at the cost of the client.
Pre-booking is not possible and cancellation/change of an appointment after 09:00 two workdays before the appointment is charged at 100% of the fee, no matter reason.
All purchases are definite and considered as klippekort, where one klip is valid one month and five klip five months.
After form and payment (cf. agreement and terms) you are immediately booked in the calender, at delay the timeslot can be taken by others, where after you are contacted for a new timeslot.
All process work (consulting, mentoring, coaching, alcohol treatment, therapy ...) is at the participants own risk and responsibility incl. health, decisions and reactions - direct as indirect.

Dansk - ved at indsende denne formular, erklærer vi igen at vi forstår og accepterer nedenstående vilkår og betingelserne på hjemmesiden:
I tilfælde af forsinkelse/fejl i indsendelse af formularen, forbeholder behandleren sig ret til at afvise kunden/disponere anderledes over tiden for kundens regning.
Præ-booking er ikke muligt og afbud/ændring af en aftale, senere end kl. 9:00, to arbejdsdage før aftalen, bliver afregnet med 100% af honoraret, uanset årsag.
Alle køb er endelige og betragtes som klippekort, hvor et klip gælder en måned og fem klip fem måneder.
Efter formular og betaling (jfr. aftale og betingelser) bookes du straks i kalenderen, ved forsinkelse kan tidspunktet blive taget af andre, hvorefter du kontaktes for et nyt tidspunkt.
Al procesarbejde (rådgivning, mentoring, coaching, alkoholbehandling, terapi ...) er for deltagernes egen risiko og ansvar inkl. helbred, beslutninger og reaktioner - direkte som indirekte.

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