Supporting Mothers

  • Blooming Families

    Supporting Mothers Agreement & Consent Form

  • Please fill out this form as thoroughly as you can to help me learn more about you and what brings you to therapy, as well as how I can best support you. All information you provide will be kept confidential and managed in line with GDPR and professional ethical standards. There are no right or wrong answers — this is simply a space for us to start your journey together.

  • SECTION 1: Basic Information

  • 3. Age Range
  • 4. What is your marital status?
    • Click to move to section two. 

    • SECTION 2: Your Current Season

    • 5. Which of the following best describes what you are experiencing?
    • 6. How long have you been feeling this way?
    • Click to to move to section three. 

    • SECTION 3: Your Relationship With Your Adult Child

    • 8. What is the current status of your relationship with your adult child?
    • Click to move to section four. 

    • SECTION 4: Identity & Emotional Landscape

    • 14. Do you struggle with guilt or self-blame regarding your parenting?
    • 15. What emotions do you experience most frequently right now?
    • 16. Outside of being a mother, how connected do you feel to your identity?
    • Click to move to section five. 

    • SECTION 5: Patterns & Awareness

    • 18. Growing up, how were emotions handled in your family?
    • 20. When conflict happens, do you tend to:
    • Click to move to section six. 

    • SECTION 6: Your Readiness for Change

    • 22. What kind of support are you looking for right now?
    • 25. Are you prepared to invest time and emotional energy into this work?
    • 26. If we decide to work together, are you in a position to invest financially in support?

  • Data Protection & Consent

    Any data held on you is anonymised and protected under GDPR (General Data Protection Regulations). Your coach is registered with the ICO (Information Commissioner's Office), registration number ZB277476. I understand my data will be processed in accordance with the UK GDPR and Data Protection Act 2018. I give explicit consent for my personal and sensitive data to be stored and used for the purpose of therapy.

  • Record Keeping

    Brief notes may be taken and stored securely. I may request access to my records.

  • Coaching Agreement

  • Thank you for choosing to work with me as your coach. I am excited about the journey ahead and honoured to support you through it. To ensure we both bring our best selves to the process, it’s important we share a clear understanding of how we will work together, so please take a moment to read the points below.

     

    Sessions  

    Our sessions are important to both of us. I will come to each one free from distractions and fully present, and I ask that you do the same. We agree to meet at the mutually scheduled time, and if you need to reschedule, please give at least 24 hours’ notice. Arriving more than 10 minutes late without notice will be considered a no-show, and the session will be forfeited. These boundaries help us maintain a healthy and productive coaching relationship.

     

    Payment  

    All payments are non-refundable, and payment plans must be completed. While I reserve the right to change fees and packages, I will honour the agreed rate for the duration of our initial agreement. If you choose to continue coaching after the initial package (which would be amazing!), the rates may change.

     

    Communication  

    I encourage communication between sessions and welcome you to reach out if you encounter challenges or want to share successes as you build the life you love and deserve. My preferred method of contact is by email at hello.bloomingfamilies@proton.me.

    Please keep messages brief and questions clear, so I can provide you with the best possible support in between our sessions.

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