She's Confident Coaching Therapy Questionnaire

She's Confident Coaching

Therapy Questionnaire
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Which therapy are you interested in? Please tick all that apply.*

Integrated Therapy - onlineIntegrated Therapy - in personHypnotherapy - onlineHypnotherapy - in personCounselling - onlineCounselling - in person
What are the main challenges or issues you are currently facing?
How long have you been experiencing these challenges?*
Have you previously sought therapy or counselling? If so, what type and for how long?
Are there any specific goals or outcomes you hope to achieve through therapy?
Please confirm; I have reviewed the fees for therapy services as listed on the website and confirm that I am comfortable proceeding based on these rates.

Yes, I have looked and I am happy to proceed.No, I have not looked.Yes, and I would like to discuss payment options (available where the fee is over £400).
Which country/timezone are you located in?
Should be Empty: