Client Record Form

Title *

So that we can best provide you with the most appropriate Coaching, please answer the following questions… and this is all fully confidential!

Are you under a doctor’s care for depression or any illness? *

Details of any medication

Do you have a medical condition that could affect the outcome of the coaching?
Are you being treated by a Psychologist or a Psychiatrist?
Have you been treated in the past by a Psychologist or Psychiatrist?

On Average how many of each of the following do you consume per day?

Do you think you are overweight? *

Declaration. I understand that coaching for most issues consists of a series of consult and 5 sessions. No guarantees are given due to the variety of issues, the client’s personal situation and coaching chosen at the discretion of the coach.

I confirm all the above details are correct.

Please supply if you can the email address of the person who referred you.

Payment Options 

All consultations (for new clients) are to be paid in advance, following sessions and programs are invoiced after the session, please pay immediately. 

I invoice directly from my accounting program. Payments are through PayPal or If you prefer to direct deposit, the details are at the base of that invoice. 

If the invoice is to be in a company name, please complete this below as it is tax deductible as ‘Professional Development’.

The Consultation Session

The F3-Performance coaching consultation allows me to understand your individual situation.

We look at where you want to be, what has been stopping you and what needs to be resolved to allow your potential to be achieved.

The consultation discussion is essential and before any coaching begins to ensure you are aware of   exactly what we are going to embark on.

The consultation allows us to really get into what changes are needed for you to become the person    that can achieve the dreams and goals you have.

As best as you can, please complete the following questions. This will form the basis of moving forward. This is a result driven coaching program so this may be as much ‘past reflection’ as I need to do for you to move forward.

If you are not sure on what you want to achieve or who you can be, this will evolve out of the discussion. Please do not request changes to be made to this process. It is set this way because it works.

Following the consultation, we will have a great awareness of what is required, and we   will discuss a plan of attack, I will recommend this plan based on your required results and your current situation.