Coaching Form

Welcome to my world beautiful soul,

I am so proud of you for taking this step on your journey to living your best, most beautiful & bold life!

Please fill in your information on the form below so I can get to know you better before our first session.

I cannot wait to watch you flourish! All the love,

Janine x

FULL NAME

PHONE NUMBER

ADDRESS

DATE OF BIRTH

TIME OF BIRTH

PLACE OF BIRTH

DO YOU HAVE ANY MEDICAL CONDITIONS OR ISSUES I SHOULD BE AWARE OF?

DO YOU HAVE, OR HAVE YOU HAD ANY LIVED EXPERIENCE WITH MENTAL HEALTH?

HOW DID YOU HEAR ABOUT ME?

WHAT ARE YOUR SHORT TERM GOALS OR HOPES FOR THESE SESSIONS?

WHAT ARE YOUR LONG TERM GOALS OR HOPES FOR THESE SESSIONS?

IS THERE ANYTHING ELSE YOU WANT ME TO KNOW BEFORE OUR FIRST SESSION?

AGREEMENT:
MY COMMITMENT:
As your Coach I will provide coaching in a professional client relationship that is designed to facilitate the creation and development of personal, professional or business goals and to develop and carry out a strategy/plan for moving towards that goal. At times I may gently challenge you, this is so that you can increase your skills and knowledge so that you can achieve the outcomes you desire.

YOUR COMMITMENT::
Your full participation during and after the sessions is required as it is your commitment to your goals which will allow them to happen. You agree to be honest and open, believe in yourself, adopt a positive outlook and commit to the process of change.
You are responsible for creating your own results and no guarantees or warranties can be given. You are solely responsible for creating and implementing your own physical, mental and emotional well-being, decisions, choices, actions and results arising out of or resulting from the coaching relationship and interactions with myself as your Coach.
You are aware that coaching is not counseling, psychotherapy, psychoanalysis or mental health care, treatment or therapy and is in no way a substitute for professional medical, legal, business or other qualified professional advice. If you are under medical or psychiatric care which will impact on our coaching now or in future, you will need to provide written confirmation from your Doctor/Practitioner that it is appropriate for you to proceed/continue.

ETHICS & CONFIDENTIALITY:
Coach agrees to maintain the ethics and standards of behavior established by the Australia and New Zealand Coaching Alliance (ANZCAL). It is recommended that the Client review the ICF Code of Ethics and the applicable standards of behavior.

BY CHECKING THIS BOX AND SUBMITTING THIS FORM, YOU AGREE TO THE ABOVE.