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The Navigator: Work with Me

Hi, Rebecca here, thank you for choosing me to work with you on your transformation journey! To make things easier for us to get started, I created this simple form to allow you to share some background about your priorities (we don't have to remember these initial details if we write them down).
Once you have answered the questions, at the bottom of the form there is a link to book your free 30 minute intro call. If you need help with the form, or to ask any questions about the programme, pick a slot!
If we have already connected I'll be in touch to schedule our first session. See you soon!

Let's start with the basics.

What is your first and last name?

How do you identify?

How do you identify?
A
B
C
D

How would you like me to refer to you?

How would you like me to refer to you?
A
B
C
D

What is your phone number?

What is your email address?

What is your address?

Who should I contact in case of an emergency?

What is their phone number?

Let's dive deeper.

If you can, please answer these questions no matter how briefly. They are all themes we will explore in our time together so anything you can share will help us get started. Even if it's a question or something you need me to help with in our sessions!

What is your driver for seeking change?

What are the top 3 things you're interested in changing?

Please share the obstacles you feel like you're facing when it comes to achieving your goals?

What have you tried already? Has it worked for you?

What does success look like for you in achieving your goals?

What are your expectations of our coaching relationship?

What are you willing to work on to reach your goals?

What aren't you willing to do to reach your goals?

What are your biggest strengths?

On a scale of 1-10, how committed are you to making a change?

I can support you to create your goals and a plan to achieve your dreams. Ultimately it's on you to implement!
0 being "I really CBA" and 10 being "I was born ready"
On a scale of 1-10, how committed are you to making a change?

Our sessions will be held via Google Meet. If you need any practical adjustments or accommodations to make coaching work for you, please share:

Access to Work

Access to Work is a UK Government grant to help people with disabilities stay in work by providing funding for coaching, support workers and more! You can apply for it even if you haven't had a formal diagnosis e.g. ADHD - you just need to be in work, including self-employment.
Please note I am currently unable to accept payment directly via an employer.

Which of the following applies to you?

Book your call

Look at the calendar below for a free 30 minute intro slot, and book a call at a time that works best for you.

Thank you for your time in completing this form, I can't wait to work with you.

Love and light,

Rebecca