NEW COACHING CLIENT ASSESSMENT
This form will take only 1 minute and is designed to help you narrow down your focus and set a clear goal and it'll help me to tailor the session for you. It can be also used to help you track progress and stay on track, or change course.

All information will  be kept confidentially.
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Email *
What are the main topics you'd like to focus on? (optional)
Could you summarise your main goal in one sentence? (Eg. I'd like to become more calm and learn how to deal with my anxiety in a useful way.) *
QUICK HEALTH CHECK.
Roughly, in the last two weeks, how are you?
Stress levels
I roll with things calmly
I'm SO stressed!
Clear selection
Anxiety levels
Confident in my ability to manage
Very anxious most of the time
Clear selection
Anger levels
I deal with things calmly and assertively
Aggressive or holding bitter resentment regularly
Clear selection
Sadness levels
Mostly happy. Sadness passes easily
I'm stuck in feeling sad, depressed or hopeless
Clear selection
Overwhelm and Burnout levels
Coping well with the problems of life
Coping poorly, feeling very overwhelmed!
Clear selection
Confusion / Stuckness Levels
I have a clear mind and can plan ahead well
My mind is confused and I feel stuck
Clear selection
Procrastination levels
Achieving what I want
Constant procrastination and avoidance
Clear selection
Physical pain/ sickness levels
Healthy body, relatively pain free
Severe daily aches, pains and physical problems
Clear selection
Do you feel you have any conditions, (phobias, emotional or physical traumas, triggers etc) or concerns that may be helpful to tell me about?
If not, leave blank
Emergency Contact (Just in Case - Name, number, relationship) Eg. Sally Morbey, 0745885588, Mum. *
SIGN UP: MAKE A COMMITMENT
The satisfaction in my work comes from helping people to achieve their main goal. This only works if you do - If you are willing to practice, which is why I ask people to, literally , sign up to the following:

Check all of these if you agree to: *
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How much will you be pay (and by bank or PayPal)?  (Eg, "Paid £xx for coaching session, by PayPal") See payment info here: https://www.positively-mindful.com/payment.html  and fee info here: https://www.positively-mindful.com/11.html 
A copy of your responses will be emailed to the address you provided.
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