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Coaching Registration Form

Please complete the form below providing some information about yourself and what you are looking for. This will help me understand your challenges and specific needs. After considering your request, I will offer you a free initial consultation (billable as part of a package if you decide to enroll in coaching). Your privacy is important.

Name *

First

Last

Address

Post Code *

Email *

Phone *

What are you looking for?

Life Coaching
Health/Fitness Coaching
Startup Coaching
Business Coaching
Relationship Coaching

What are the issues you seek to overcome?

Building confidence and self-esteem
Getting rid of limiting beliefs
Figuring out life direction
Self-development
Improving communication
Help with relationships
Clarity in your mind, life, home
Get in shape / Get more energy
Managing stress better
Dealing with a transition in life
Starting your business
Trapped & overwhelmed by life's demands
If anything else please write below

What are your hopes and expectations from coaching? *

Which days are you available? *

Any day is fine
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

What times are you available? *

Any time is fine
Morning (9am-noon)
Early afternoon (noon-3pm)
Late afternoon (3-6pm)
Evening (after 6pm)

What is your age? *

What is your gender? *

What is your relationship status? *

Consultations *

Coaching consultations/ sessions will allow you to address issues you seek to solve. The coaching consultations/ sessions will help you see things in new ways, but ultimately you remain responsible for any decisions you make or actions you take and the outcome of it.

Confidentiality *

Ccoaching is a professional and confidential relationship between you and your coach. Your coach agrees to keep your information private unless you give them specific permission to disclose it.

Limits to Confidentiality *

There are limits to the security of online conversations (type written) and via Skype. While your coach will not disclose any details to others, there is currently no guarantee that someone else cannot access (hack) a copy of online or Skype discussions.

Limits to Confidentiality *

If your coach comes to the conclusion that you or someone else may come to serious harm, they might advise you to contact your GP, Social Services etc. and if necessary, do so themselves.

IMPORTANT: Your information remains confidential unless there is a risk to your personal safety or the safety of a child or vulnerable adult. By using the registration form, you agree to Dauntless Minds 'Privacy and Data Protection Policy' and how we protect and use your submitted information.

Terms of Payment *

All compensation is paid prior to the first session and is non-refundable. For individual session consultations you will be asked to set a Direct Debit. The consultation fees due will be debited from your account on the day of each appointment.

Cancelations / Changes *

If you need to cancel or reschedule a session please give as much notice as possible, at least 48 hours before you session. A cancelled, missed or changed appointment with less than 48 hour notice is charged the usual session fee.

With your name and today's date you indicate that you understand and agree with the above terms. *

First

Last

Today's date *

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Becoming Comfortably Confident

Upcoming Free - Your Life's Core Foundation

How to Gain and Maintain the Confidence & Clarity to get ANYTHING you dream of. On your terms.

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HEAL & THRIVE

What would it be like to live more vibrantly from the Inside Out?

Any setback can be a trailhead to immense opportunities to heal our past trauma, change how we live in the present, and create a future based on who we truly are rather than who we expected to be.

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