Las Vegas Spiritual Life Coach Jaclyn Costello

Inquiry Form

  • Contact & Background

  • A Bit About You

  • Your Goals

  • Expectations about Coaching

  • Cancellation Policy

    Appointment times are valuable and irreplaceable. Please arrive (or be at your phone) promptly to obtain your full session. If you need to reschedule, please let me know two days in advance. I prepare and set aside time devoted exclusively for you, so unless cancelled 48 hours in advance, you are financially responsible for the time reserved. The same policy applies to prepaid success packages. If you must reschedule an appointment due to an emergency, notify me as soon as possible. Thank you for your consideration.
  • Confidentiality

    Your information, correspondence, and our private conversations will always remain 100% confidential and safely guarded. You have a right to be allowed access to any written record I have about you; though I will not release any information to anyone without a written authorization from you, except as provided for by law.
  • Consent and Release

    By typing my name in the box below, I declare that I am over the age of 18 years old* and hereby agree, voluntarily and freely, to receive information from Jaclyn Costello, Grow with Soul, and I understand that Jaclyn Costello is not a licensed health care practitioner and that the information I will be receiving is not legal, therapeutic or personal advice and cannot be considered as such. This information cannot replace or substitute for the services of trained professionals in any field including, but not limited to, psychological, financial, medical or legal. I understand that I should consult a medical professional concerning any symptoms that may require medical attention. I also promise to disclose any prior or existing or mental health condition to Jaclyn Costello. I further release both Jaclyn Costello and from being held liable in any manner whatsoever stemming from my use of the information I will be learning, including, but not limited to, injury, illness, economic loss, harmful effects, emotional distress or death. I assume full responsibility for the consequences of my own decisions and actions. I have also read the Terms and Agreement pages on the website, and I agree to the terms outlined there. I declare that I have read this consent and release, and that I fully understand and agree to its terms. Check here to confirm you accept these terms.
  • —Anyone under the age of 18 who will be receiving consultation services from Jaclyn Costello must have a parent or legal guardian contact me ( for a separate form.
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