Clarity Call Request Form
From Stuck to Successful
Full Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: 00000 000000.
Email
*
example@example.com
Type of enquiry
ADHD Coaching for Professions- request a clarity call
Therapy/ mental health support
Other
Kate prides herself on being transparent. Have you read the brochure below detailing what Black Dog Coaching offers including investment/fees?
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Yes
Not yet- please follow the link below to the brochure
ADHD Coaching Brochure
Enquiry Details: Top 3 ADHD challenges
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How can we help? How does your ADHD/ neurodivergence hold you back? What are the challenges that you wish to work on? Please state the best time to contact you & your availability.
Please select the best way to contact you:
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Phone
Email
SMS
WhatsApp
How did you hear about us?
Personal referral
Magazine/advert/flyer
Social media
Search engine
Other
Data & GDPR
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I understand that by submitting this form, I agree to be contacted regarding my enquiry. Information shared on this form will be encrypted and stored securely in accordance with the Data Protection Act (1998). All information shared will be held in the strictest of confidence by Black Dog Coaching. Your data will never be passed to third parties.
You consent to us processing this sensitive data in order to provide our services. Follow this link to our Privacy Policy to find full details of how we process your personal data: www.blackdogfamilypractice.uk/privacy-policy
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