Compassion Key Intake Form

Name: (required)

Phone Number: (required)

Email: (required)

Please take a few minutes to thoughtfully answer the following questions.

Please tell me about the challenge or challenges you wish to transform. Please share as little or as much as feels right for you in order to help us get started: (required)

Some ideas of information you might choose to share include: What are the issues or challenges? How long have you had them? What are the steps you have already taken to address these issues? How much time and money have you already invested in transforming this challenge?

Are you making good progress and want bigger, faster results, or are you feeling pretty stuck? (required)

What other info would help give me a basic idea of your situation? (required)

Do you believe it is possible for you to completely transform or significantly improve your situation right away or over the next few months? (required)

Yes, No, or Maybe/Not sure. Plus explain why you answered this way?

Would you like me to send you a recording of your session after it's complete? (required)

Yes

Terms & condititions: (required)

I understand if I reschedule on less than 24 hours notice OR show up more than 10 minutes late to my appointment, I will be considered a no-show, and I will lose my session and not be entitled to a full or partial refund. I understand & recognise that The Compassion Key and any other tools and processes Eloise employs are only one potential factor in the management of my physical and mental health, my financial life, my relationships or any other part of my life. And that the work I do together with Eloise may in fact have no impact on my physical or psychological health or any other part of my life. I also recognise that ultimately it is up to me whether I choose to follow the information and guidance provided by Eloise and that it is advisable for me to consult with medical or mental health professionals with regards to matters related to my physical and mental health, and consult with other licensed professionals with regards to legal or financial matters or other matters that might require specialized support from licensed professionals.

Agreed