EmailMeForm
1-Hour Initial Session = $100
2-Hour Workbook Session = $200
1-Week Interactive Workshop = Tailored program and cost with a $50 down payment for the initial 1-hour strategy session
Step 1:
Complete this form so Dr. HermanSJr. can tailor sessions based on your needs, situation, vision, mindset, and goals. (For the 1-week long workshop-program the value-based cost and strategy will be discussed on the initial strategy session after you make the $50 down payment during this 3-step process; all other services will be completed in full on the date/time you schedule with Dr. HermanSJr. after you make the full payment during this 3-step process.) You will then be directed to PayPal to make the proper payment for the proper service - no PayPal account required.
Step 2:
Make the proper payment for the proper service. You will then be directed to Calendly to schedule the service (the initial strategy call for the 1-week long workshop program, or the full service of all other sessions).
Step 3:
Schedule the session with Dr. HermanSJr.
* Falsification to any extent will void enrollment.
Name
*
First
Last
Gender (used to help determine cognitive capability)
*
Female
Male
Trans
Age (used to help determine cognitive capability)
*
Marital status (used to help determine cognitive capability)
*
Married
Single
Email
*
Confirm
Residence country
*
Residence city/town
*
Method of contact for appointment
*
Google Hangouts
In-person (if in same vicinity as Dr. HermanSJr.)
Line
Skype
Telegram
Traditional phone
Whatsapp
Contact information for appointment
*
Highest completed educational level/standard
*
Under 8
8
9
10
11
12
Associate
Bachelor
Master
Doctorate
Post-Doctorate
Currently enrolled in an educational institute?
*
No
Yes
If yes, educational goal in that institute?
Employment
*
Full-time commission
Full-time hourly
Full-time salary
Internship - Paid
Internship - Unpaid
Part-time commission
Part-time hourly
Part-time salary
Unemployed
If employed, title/designation?
Yearly income calculated in USD (used to tailor program strategy and level)
*
<$500
$501-$1,000
$1,001-$2,500
$2,501-$5,000
$5,001-$10,000
$10,001-$25,000
$25,001-$50,000
$50,001-$75,000
$75,001-$100,000
$100,001-$200,000
$200,001-$500,000
$500,001-$1,000,000
>$1,000,001
Top reason for session
*
I accept the refund policy that no refunds are available for any reason.
*
Yes
Powered by
EMF
Free Form Builder
Report Abuse