Name
*
First Name
Last Name
Email
*
Phone
*
Birthdate
*
Address
*
What would you consider to be your personal strengths?
What personal goals, if any, have you set yourself?
What professional goals, if any, have you set yourself?
What are your passions in life and what makes you happiest and most fulfilled?
What's missing in your life?
Are you aware of any behaviour's/ beliefs/ blocks that get in the way of living the life you truly want?
What motivates you or gives you energy?
Do you feel ready in yourself to start to make the changes in your life to move forward?
Is there anything else you think is important and would like to share?
Acknowledgement
*
I understand that Intuitive Development Coaching is a facilitated conversation that enables you, the client, to engage in and discuss your processes to allow you to work through them with the support of the therapist.
I understand that the therapist does not treat, prescribe for, or diagnose any illness, disease, or any other physical or mental disorder, injury or condition. (Nothing said or done by the therapist will be construed as such.)
I further understand that the therapist is not attempting to practice medicine, psychology, counselling or any other profession requiring a licence under New Zealand Law.
I understand that, for the safety of the therapist or myself as the client, I may be referred on to another practitioner for support, if required.
I authorise the therapist to make notes and use information about me for the purpose of the business.
If I choose to make an audio recording of any session, it is for my personal use only, and I agree not to share it on any platform or with any other person.
I will not make a video recording of any session.
I give my permission for relevant information about my medical condition/s and/or treatments to be shared with other Wellness New Zealand practitioners if I choose to seek complimentary treatment from those practitioners.
