Welcome.
Let's start here.

Before we begin, I'd love to get to know you a little. There are no right or wrong answers here — just be as honest as you feel comfortable being. Everything you share stays completely confidential and helps me support you in the best way possible.

About You

First name *

Last name

Age

PronounsSo I can refer to you correctly

Email address *

Phone numberFor WhatsApp if needed

Where are you based?Country / timezone helps with scheduling

Instagram handleOptional — helps me get a feel for you before we speak

How did you find me?

Where You Are Right Now

In a few sentences, where are you at right now in your life?This can be anything — emotionally, personally, professionally. Just be honest.

What made you reach out now? What was the moment or feeling that pushed you to take this step?

How would you describe your current mindset or emotional state most days?

On a scale of 1–10, how happy are you with your life overall right now?1 = really struggling, 10 = everything feels great

Really strugglingEverything feels great

What You Want

What do you most want to change, shift, or work through?Be as specific or as open as feels right

What areas of your life feel most important to work on right now?Select all that apply

What does success look like to you at the end of our work together?If everything went perfectly, what would be different?

Is there anything stopping you from making changes or moving forward right now?

A Little Background

Tell me a little about your life — whatever feels relevant.Relationships, family, work, where you live. Anything you feel I should know to understand you better.

Have you done any coaching or therapy before?

If yes — what helped, and what didn't?This helps me do things differently where it matters

How do you best receive support?There's no wrong answer — this helps me show up for you in the right way

Wellbeing & Safety

This section is completely confidential. I ask these questions because I care about your wellbeing and want to make sure I support you safely and appropriately. You only need to share what you're comfortable with.

Is there anything going on with your physical or mental health that you'd like me to be aware of?e.g. diagnosed conditions, medication, ongoing treatment, health anxiety, grief

Are you currently under the care of a GP, therapist, or other professional?

Is there anything you'd like me to know before we begin — anything that would help me hold a safe space for you?

Your Commitment

On a scale of 1–10, how committed are you to doing the work and making real changes?Be honest — this isn't a test, it helps me understand where you're at

Not sure yetFully committed

Is there anything that might get in the way of you showing up fully?e.g. time, finances, fear, other commitments

What's one thing you'd love me to know about you that isn't captured anywhere else in this form?

I read every single response thoroughly and personally. Once I've been through yours, I'll be in touch to let you know whether I feel I'm the right person to help you — because getting that match right matters to me.

Just so you know — I'm not a therapist. What I do is help you become a better, stronger, more confident version of yourself. This is about growth, mindset, and real change.

iamchloelawless · Confidential · All responses are private