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Acorn Consulting Intake Form

What is your first name?

What is your last name?

How did you hear about me?

How did you hear about me?
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What is your mobile phone number? (please specify country code)

What country are you usually in? (for time zone)

What is your email address?

What specific areas of your life would you like to work on through coaching? (e.g., career, relationships, personal growth, health, confidence, addiction etc.)

Have you had any previous experience with coaching, therapy, or counseling? If yes, please provide details:

What do you expect to achieve through coaching?

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

On a scale of 0 - 10, how would you rate your emotional wellbeing currently?
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Payment & Cancellation Terms

Invoices are sent in advance for the full month ahead.
Pre-payment is due no later than the 1st of the 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 Linda's discretion.
If you wish to cancel your coaching arrangement with Linda, then 1 month's notice is required.
By clicking the yes button below, you're agreeing to the payment and cancellation terms and that all of the information you've provided above is accurate and up to date to the best of your knowledge.
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Contact

If you have any questions, please don't hesitate to ask.
Linda Jean
+27 (0)83 357 3473
[email protected]
www.acorn-consulting.co.za
Insta & FB @acornconsultinglindajean