How can I help You?
Please fill out the form below providing as much information as possible in the spaces provided.  This information will help us laser in on your specific needs during our scheduled phone call, maximising the value for you to identify a workable solution.

Once you have completed the form, please press Submit (at the bottom of the form)

Your answers will remain totally confidential.

OptiMum Health, Potterhanworth, Lincoln.
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Email *
First Name *
Last Name: *
Your preferred contact number: *
Your preferred email address *
Date of Birth
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Which of the following are you interested in? *
What would you most like my help and support to achieve? *
What are you currently struggling with or what would you like further support with right now?  
Why is this important to you?
How would you like things to be different both now and in the future?
How is this affecting you within your life at the moment? *
If you don't take steps to address the area with which you would like support, or feel stuck with, what would be the consequence for you?
How long have you been trying to achieve this & what have you tried so far? *
Thank you for completing our form - I'll be in touch soon.  By submitting this form you accept that I will use your data for the purpose of making contact with you, via email &/or phone, to discuss ways in which I may be able to support you.  Further details of how your data will be stored and used can be found in my Privacy Policy by clicking this link:
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