Pre-Course Questionnaire
Name
First
Last
What would you like us to call you?
Preferred pro-nouns
Email
(Required)
Phone
What Course Have you Enrolled in?
(Required)
Do you consider yourself to have any form of disability? If so please provide details and let us know if you need any reasonable adjustments to be made to allow you to fully participate in the training.
(Required)
If you could have anything as a result of this program – what would you want? (stated in the positive)
(Required)
What do you anticipate you will get from this program? What do you believe is possible?
What do you currently have in your life which you no longer want?
What do you NOT currently have in your life which you DO want?
Write a short life history in note form including significant events to you (positive and negative).
What patterns have you noticed occurring in your life so far?
Give details of any other coaching/therapy undertaken to date.
Terms and Conditions
(Required)
I agree
I understand and agree that this information is dealt with in the strictest of confidence and held and used with the upmost respect in accordance with your privacy policy.
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