step
X
of
X
Have you had any experience with life coaching or similar services before?
Yes
No
If yes, can you give a brief description of your experience?
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What areas of your life would you like to focus your sessions on?
Check all that apply
Career
Emotional-wellbeing
Confidence
Family/Relationships
Personal Growth and Development
Stress Management
Work-Life Balance
Other (Please specify)
Other
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Next
Which of the following challenges and obstacles apply to you?
Check all that apply
Time Management
Career-Related Challenges
Relationship Issues
Self-Confidence/Self-Esteem
Work-Life Balance
Personal Development
Other (Please specify)
Other
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Next
What coaching format would you prefer?
Please select at least one
(required)
Zoom (Video)
Zoom (Audio Only)
Phone Call
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Do you have any disability or are you neurodivergent?
Yes
No
If yes, can you give a brief description of your disability or ways we can help accommodate your condition.
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Do you have a preference of Gender for your coach?
Male
Female
No Preference
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During your sessions, would you be interested in any of the following extra tools?
Check all that apply
Psychology tools and exercises
Psychology theory (to understand your brain better)
Breathing exercises
Visualisation exercises
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Are there times that would be more suitable for your sessions?
Leave blank if you have no preference
Morning
Daytime
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Let’s get some information about yourself.
First Name
(required)
Last Name
(required)
Age
(required)
Select one...
18-25
26-35
36-45
46-55
56+
Occupation
(required)
Gender
(required)
Please select one
Woman
Man
Non-Binary
Transgender Woman
Transgender Man
Agender/I don’t identify with any gender
Prefer not to state
Gender not listed
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What are you contact details?
Email
(required)
Phone Number (optional)
How should we contact you?
Email
Phone
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Great, that's all we need to know! Do you have any other information? If not, please press submit and a member of our team will be in touch
Other information
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