Clarity Questionnaire

Submit the form below and then you will then be able to book your free
30-minute clarity call.

What would you like to work on?

Have you been diagnosed with a mental health issue?

Are you currently taking any prescribed medication?

Are you worried about heavy drinking or drug use?

What do you hope to get out of our sessions?

Am I ready for change?

Are you prepared to commit to sessions every fortnight?

Are you prepared to do the homework?

What are you prepared to let go of to move forward?

Have you tried coaching or counselling before?

Is there anything else you would like to tell me?

Name

First Name

Last Name

Telephone Number