Lottelife individual session Form

Any personally identifiable information received is kept confidential. All personal information shared will only be shared as necessary for the welfare of the participants. Personal information collected is stored in a secure location and safely destroyed after it is no longer legally required.

Personal Details

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Emergency Contact

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Do you have a history of, or have you recently experienced any of the following?

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If you answered “yes” to any of these questions, please explain or elaborate below or alternatively explain in an email.

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PLEASE READ AND SIGN THE FOLLOWING STATEMENT

I hereby confirm that I have read and understood the above information, and have answered all questions completely and honestly, and have not withheld any information. If I am submitting this form electronically, I agree that my typed name and the digital signature below shall be the binding, legal equivalent of my actual signature.

I have read, understood, and have truthfully answered the above questions.

If I have indicated a potential concern, I have provided details.

 

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Contact Lotte

Email: [email protected]

Mobile: +61  422 989 551

Skype: lotte.schultz

WhatsApp: +61 422989551

Facebook: lottelife page

Instagram: lottelife1

 

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