Intake Form

This form is only for those who have completed a free introductory session (call or in person).
Your information is treated in the strictest confidence and according to our privacy policy. However, you can carry this out over the phone if you do not wish to submit the form electronically. Simply call me instead on 07974 575 422.

Contact Details
Your Name *
Your Name
Address *
Address
Coaching Knowledge and Style
There are more direct styles with a focus on strong motivation and accountability, or softer style focusing more on your direction if you are already highly motivated and accountable.
Client History
This helps me assess where you are and how best to support you. The more information you provide, the more effective our sessions will be. You are not obliged to answer all the questions and can ‘pass’ or ask me for further clarification if you need.
This is usually the reason why you requested coaching.
Indicate whether you tend to think more about the past, present or the future.
If you don't know, take a free test–which takes less than 12mins and select your type from the menu. Take Myres Briggs Test
Preferred Session Slot
Once you have selected your preferred session slot and made payment, I'll be in touch to book the specific date and time.