Data Form

New Client - Data Form

Please complete this form before your first session.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

DayMonthYear
Date
Medical Details

These answers help in case medical assistance is required during our sessions
Doctors Name:
Doctors Surgery:
Surgery Phone Number:

Area CodePhone Number
Do you take any prescribed medication at all? If so please give names and dosage.
Do you have any ongoing medical conditions? If so, please give details
Have you had any general accidents or any surgery in the last 3 months?
Lifestyle Details
Relationship Status
Occupation
Do you have any children?
If yes please give ages:
Who lives within your household?
Briefly state what is it that you would like to change? Also note anything you think I should know ahead of your appointment.
Space expands so type away!
Newsletter
Please verify that you are human

Terms and Conditions
Booking your sessions:

*Payment must be made in full when booking each session by BACS transfer or by PayPal.

*Coaching sessions take place in via zoom, you will be emailed a link for each session.

*The length of a session lasts 50 - 70 minutes, please make sure you have enough time to complete the session when booking.

* Sessions should be booked no less than 1 week and no more than 2 weeks apart to achieve the best outcomes.

*I ask that you please respect the time of your session and arrive punctually. If you are more than 15 mins late then you are noted as not turning up for the session as there will not be enough time to complete a session before the next client and you will forfeit your coaching time (and pay the associated fee for coaching).

*If you need to change a session please contact me by e-mail. Please do not leave answer-phone messages as I will likely miss these.
Cancellation Policy:

*Please inform me of scheduling conflicts more than 48 hours in advance of our session. I can usually re-fill the session time as I generally have a waiting list and when given sufficient notice, can fill a space. Changes with less than 48 hours notice will be charged at 50% and less than a FULL 24 HOURS notice will be charged the full fee. Cancellations, without rebooking, will be charged at 20%.

*You will be asked to complete a pre-appointment form before each session. As we conduct our sessions over zoom if you have symptoms of Covid-19, or in the contagious stages of a cold / cough / flu / tummy bug etc, we will still have the session, unless of course you are too ill in which case please email to cancel and rearrange your session, however short the notice! In this instance the usual cancellation policy will not apply.
By submitting this form I am agreeing to the above points, including the cancellation and illness policy.
Should be Empty:

New Client - Data Form

Medical Details

Lifestyle Details

Terms and Conditions