Intake Call - Information sheet.

The Comm 1:1 coaching-
EOI Intake Form

All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent.

Full Name

First NameMiddle NameLast Name

Phone Number

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E-mail

Emergency Contact

Phone Number

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Occupation

History

1. List the main points you'd like help to change - these can be in the form of a goal, or your intention for working with a 1:1 personal coach

2. Think about your definition of 'happiness' or your 'ideal life'. If you were to know, what specifically does it look, sound and/or feel like to you?

3. List any traumatic events that you have experienced in your life, and the age at which you were when they occured if you were to know. You are encouraged not to judge your experience rather to bring whatever needs to be resolved into the therapeutic space.

4. Are you left or right handed with a pen?

5. List Areas of Physical Discomfort, Injury or Pain

6. Describe Onset of Discomfort or Pain including how it is affecting you now (or N/A)

7. List all current 'health' conditions/ concerns including psychological - write 'N/A' if not applicable

8. What previous personal development have you done, and enjoyed or not enjoyed? - Including which modalities/ professionals you have worked with.

9. Copy the web address below & complete the quiz in a NEW window to determine your Rep system scores- Auditory, Visual, Kinesthetic, Auditory Digital. When completed list your scores in the text box below: https://www.transformdestiny.com/nlp-guide/nlp-representational-systems-preference-test.asp

Youtube

10. Open the link above in a new tab and complete the youtube activity on 'The Wheel of life' - Please bring this to your session & Send a photo to your Trainer. Any comments/ reflections on your result?

Please note you will be required to sign a waiver acknowledging your personal responsibility to good health & protection against injury, whilst maintaining that Gabrielle Anne Wright training takes every precaution to support you in this. Please sign to demonstrate your understanding.