Informed Consent & Welcome
A gentle first step before we begin our 1:1 work together. Please read each statement carefully and tick the boxes to show you understand.
Before You Begin
This form has three short pages. You can pause and come back at any time.
Page 1: Informed consent, emergency contact and your signature.
Page 2: Your health history and lifestyle.
Page 3: A short capacity check to help me understand where you are today.
Everything you share is kept private and used only to support our work together.
Please Read & Tick Each Statement
Each box is required so I know you have read and understood.
1. Coaching Is Not Medical Care
I understand that Carolyn is a coach, not a doctor. She does not diagnose illness or give medical advice. If I am unwell, I will speak to my doctor.
2. I Am Choosing To Take Part
I am doing this coaching because I want to. No one is forcing me. I can stop at any time.
3. What I Share Is Private
What I tell Carolyn stays between us. She will only share what I say if she is worried I might hurt myself or someone else, or if the law says she must.
4. I Am In Charge Of My Choices
Carolyn will share ideas and tools with me. I get to choose what I do with them. My results depend on what I put into the work.
5. Big Feelings May Come Up
This work can bring up strong feelings sometimes. I will tell Carolyn if I feel overwhelmed. If I need more help, I will speak to a doctor or therapist.
6. Sessions, Payments & Cancelling
I know when my sessions are and what they cost. If I need to cancel or move a session, I will give at least 24 hours notice when I can.
7. In An Emergency
If I am in danger or having a medical or mental health emergency, I will call 999 or my doctor. Coaching sessions are not for emergencies.
Your Details & Signature
Please tick each consent statement above, share an emergency contact, and sign below to complete Page 1.
Once submitted, you'll be taken to Page 2: Health History.
Thank You For Taking This First Step
Completing this intake helps me hold your story with care and gives our sessions a strong, honest foundation.
Questions? Email hello@harmoniance.co.uk
