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Brenda Clarke Consulting - Intake Form

Name and Surname
Mobile phone number (Please specify country code)
Email address
What country do you live in?
Briefly describe your current life situation and what led you to seek life coaching?
What are your primary goals or objectives that you hope to achieve through life coaching?
Have you worked with a life coach or therapist before? If yes, please describe your experience:
Are there any specific challenges or obstacles that you're currently facing?/
What do you expect from the coaching relationship?
On a scale of 1 to 10, how satisfied are you with your current life overall?
How did you hear about me?
Untitled multiple choice field
A
B
C
D
E
F
G
Which online platform do you prefer for online sessions?
Untitled multiple choice field
A
B
Terms and Conditions:
Invoices are sent in advance for the full month ahead.
Payment is due no later than the 1st of the coming month.
Sessions may be changed or cancelled up until 48 hours prior to the appointment, after which time they will be forfeited (charged for). There are exceptions in the case of emergencies / unforeseen circumstances and these are at Brenda's discretion.
If you wish to cancel your coaching arrangement one month's notice is required.
By clicking and signing below, you are agreeing to the terms and conditions above. You also agree that all of the information you have provided above is accurate and up to date to the best of your knowledge.
Signature
Contact details:
If you have any questions please feel free to ask me. I can be contacted preferably via WhatsApp.
Brenda Clarke
+27 82 887 4298
[email protected]