Coaching Application Form Name * First Name Last Name Email * What coaching option are you interested in? * 1 Coaching Session - 50 mins £150 5 Coaching Sessions Deep Dive Bundle - 50 mins x 5 £600 What is your experience working with therapists or similar professionals? * 100 words max What issues are you looking to receiving coaching for? 100 words max What are you hoping to achieve from this coaching? * 100 words max What is not working with your current approach? 100 words max What is your availability for a 20 minute discovery call? Please include your country location as well as times and dates. * Are you currently experiencing thoughts of self-harm or suicide? * If you answered yes, please reach out to a mental health professional or crisis helpline immediately. My coaching is not the appropriate service for this type of issue and is not a substitute for clinical mental health treatment. Yes No Are you currently in crisis or need immediate mental health support? * If you answered yes, please reach out to a mental health professional or crisis helpline immediately. My coaching is not the appropriate service for this type of issue and is not a substitute for clinical mental health treatment. Yes No Do you understand that this coaching is based on personal experience and practical insights, and is not a form of or replacement for therapy, counselling, or medical treatment? * If you answered no, please contact a mental health professional as they will be able to provide you the relevant support. Yes No Are you over 18 years old? * Please answer honestly, I only work with those over 18. If you are under 18 please ask your parent or guardian to fill out the form, specifying that it is on behalf of someone else under 18. You would both be on all the calls together. I am over 18 I am under 18 Thank you for submitting your application form. I will read through your answers and if you are a good match for my coaching, and if there are slots available, I will be in touch. If there are any issues please email me at hello@rumziyousef.com
