As a new client, I would like to thank you for placing your trust in me. To begin, I ask for some information that will assist in planning our sessions. Your answers here will be used to serve you appropriately, so please provide all the information that you think will be helpful for me to know. Client enrolment Please enter your name * Your street address * Your town * Your postcode * Your country * Your age Email address * Phone number * Emergency contact * What has brought you here today? Please provide me with an explanation of the issue or challenge you are facing. * What are your immediate goals in relation to this issue? What would your dream outcome be? How would you like to feel or act instead? What's keeping you from success? What have you already tried, and how has that worked out? * What's the hardest part about this challenge? What worries you about it? How do you cope with your issue? Do particular thoughts or actions make it better or worse? In writing this, does it bring up particular traits that you would you like to resolve? Stress / Anxiety Forgiveness Guilt, Shame or Anger Fears, Phobias or Trauma Recovery Low Self Esteem or Shyness Relationship Issues Performance at Work Lack of Motivation Unwanted Habits Sports Performance Accelerated Learning / Test Taking Improved Concentration / Memory Body Shape Sexual Freedom Chronic Pain (already assessed by a physician) Accelerated Healing (already assessed by a physician) When you have resolved your issue and achieved your goal, how will you know? What will be different? What parts of your life do you enjoy the most? Are there any small joys or daily delights? Who are the important people in your life? In what ways are those people impacted by, or have an influence upon, the issue you are facing? Do you have any fears or phobias that it might be helpful for me to know? Feel free to expand to the extent you wish, but as examples: confined spaces, heights, the ocean, certain foods, etc. * Do you have any physical (wrist, neck, shoulders or spine in particular) or mental health challenges? Are you currently or habitually taking any medications? * How would you describe your spiritual or religious beliefs? Is there anything else that you think it might be useful for me to know? * The work we engage in is a collaborative process, so I emailed you my Client Agreement. It sets out the principles by which we will work best together. Have you received this document? I must receive your consent. * How committed are you to achieving your desired outcomes? Captcha Once you have reviewed the session principles below, click here to submit your completed form to me If you are human, leave this field blank. Δ
