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Before we continue please will you complete the client information form to enable me to provide as much value as possible.

Thank you so much and I really look forward to beginning our journey together!

Personal Info
Name
First Last
Email
Date of Birth
MM slash DD slash YYYY
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship Status
- Single
- Engaged
- Married
- Open relationship
- Domestic partnership
- Separated
- Divorced
- Widowed
- It's complicated
- I don't want to say
Next of kin name and contact details:
Name, relationship & contact details
Family Setup
Who is in your current nuclear family (partner, children etc - names, relationship to you and ages)?
Who is in your family of origin (parents, siblings etc – names, relationship to you and ages)?
Your Goals
What is calling you to take part in the Fatigue to Flow coaching intensive?
What will improvement look and feel like to you?
What has kept you from achieving this improvement in the past?
What personal development work have you done (courses, therapy, reading, other)?
Which of these have been most helpful to you and why?
What could prevent you from achieving improvement during this coaching intensive and what can you do about these factors?
Please provide a brief summary of your mental health history (diagnoses received, therapy attended, self-harm practices, if any)
Please provide a brief summary of medical treatments/interventions to manage your chronic exhaustion.
Do you have any concerns about the Fatigue to Flow coaching intensive that could stand in the way of shifts happening?

Personal Info