Application Form
Ecton Skype/Telephone Counseling Session
Thank you for your interest in a Skype/Telephone counseling session with Ecton. Please fill out all of the items below if you are applying for a session. If you are requesting more information or have comments or suggestions, please include your name and email address, then please skip to the bottom of the form to the question entry location. I will respond to your session request or inquiry via email as soon as possible.
The fee I ask for your Ecton Skype/Telephone counseling session is $185.00 USD, payable via www.paypal.com . This includes the recording media and contact method of your choice. After we schedule your session, you will receive additional payment instructions.
 

**Please include at least one phone number in case of technical problems with Skype.
 

Preferred Communication Method
Skype Landline Phone

Skype ID
(**If you choose Skype
as Communication Method)

 
**I will send you a Skype Text message requesting to be added to your contact list. Please do this before our session.
Preferred Recording Method
MP3 Cassette Tape
  Preferred Dates and Times
for your session
 
Is this your first private counseling session with Ecton?
Name of the person or website that referred you?
Questions, Comments, Suggestons?
 
**I will never give or sell your email or contact information to anyone.**