New Client Form

At least 1 day before your session, please take 15 minutes to complete the client intake form below.

If you have any questions, please complete the contact form here

Thank you and looking forward to meeting you!

Click on the box to open the form. Fields marked with a * are required.

New Client Form
Fields marked with a * are required.

Basic Information

Wheel of Life Chart
I use a Wheel of Life Chart to assess where we need to focus our sessions. To complete the chart, in each of the 10 areas below, rate out of 10 how happy and satisfied you are.

10 = blissfully happy,
0 = sad and/or frustrated.

I included a few questions to get you started and I'd be thrilled if you felt like sharing part of your journey / history / story in the box below each question!

Are you passionate about your work/study? Do you feel recognised and appreciated? Is it easy or challenging for you?

How happy are you with your finances? Do you feel there is enough to cover all your basic needs? Are you in debt? Do you have money saved? Do you feel financially recognised at work?

What is the status of your health and immune system? Do you have current health issues? Any long term chronic complaints? Do you exercise and eat well? Do you use sugar, caffeine, chocolate to boost your energy levels? Do you smoke? Are you stressed?

Are you happy with where you live?  Do you enjoy coming home? Is there nature around you at home? Is your home cluttered or tidy? Is there a TV/computer in your bedroom?

Did you have fun today? What do you enjoy doing when not working/studying? Are there areas of your life where you're able to express your creativity? (Everyone is creative!)

Are you happy with your relationship status? What is your relationship like with your family?

Are you happy with the amount of friends you have? Are you close to them? How many times per week are you doing something social? Do you think you're an introvert or extrovert? 

What do you think about yourself? What do the words self-worth, self-esteem and self-love trigger in you? Are you confident? Do you have an inner-critic?

Do you feel you are still growing and learning? Are you happy with where you are in life? Or stuck in a rut? 

What are your spiritual beliefs? Do you have a connection to Spirit / God / the Universe / a higher power? Are you uncertain or still looking?

Session Progress Tracker

Use this form to record your progress during our journey together. Once you’ve clicked on the link, save it to your computer and you’ll be able to fill it out electronically. You can then email it to me before your session.

Session Progress Tracker Fillable 2015