Ink and Scribbles Kids Coaching Expression of Interest Form
All information provided is treated confidentially in line with our Privacy and GPDR Policy and Code of Ethics.
Name
First Name
Last Name
Email
example@example.com
What is your child's age?
Which area(s) of wellbeing are you seeking support with for your child?
Confidence/Self Esteem
General Emotional Intelligence Education e.g. understanding emotions and emotional experiences
Regulation
Anxiety, Worry
Negative Thinking Patterns
Friendships
Growth Mindset
Managing Stress
Other
Is your child involved with other wellbeing interventions or services?
No
Yes: School Based Intervention e.g. Thrive, ELSA
Yes: Mental Health Professional e.g. counsellor, psychologist, Play Therapy, Occupational Therapy
Yes: Natural Healthcare Provider e.g. reflexologist, naturopath, homeopathy etc
If you answered yes to any of the above, please state the title of the provision or service.
Please give a brief explanation of your reasons for getting in touch.
On a scale of 1 - 5, how concerned are you in relation to the comments made above?
Slightly
1
2
3
4
Extremely
5
1 is Slightly, 5 is Extremely
Please confirm you are in the UK.
Yes, I am in the UK
Please verify that you are human
*
Submit
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