Candace Durand CHT

 

 

 

On a separate piece of unlined typing paper,

 write down in longhand what you want to accomplish in our work together. Please include questions (no more than 15),

Sign your name on the paper at the bottom.

Use cursive if you know it or if you can. Scan all of this and try to make it black and white, not brown, put it under a strong white light, send it to me via email, or send it by post. In care of:

Candace Durand, 2302 Rosebud Drive, Billings, MT, 59102 or durandcandace@gmail.com

 

Your name

 

Home Phone

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Cell Phone

Email Address

 

Address

 

 

 City

 

State.ZIP Code

 

Occupation/Business Type

 

 

 

DOB, age

 

Gender id--------                     / married or single

 

 

 

Additional Information (Seniors/Military/etc.)

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Time zone like MST?

 

 

 

Other/Special Requests

 

Referred by, or how did you find

 Candace Durand,2302 Rosebud drive, Billings MT 59102