Applying for Coaching at Newleaf

Pippa Adamson at Newleaf

NLP, Hypnotherapy and Life Coaching Sessions

Client Application and Agreement

How I work I am trained in Neuro-Linguistic Programming (NLP), Hypnotherapy, and Life Coaching. I am also an advanced Lighting Process® practitioner. I am registered with the British Institute of Hypnotherapy and NLP, insured by Balens Ltd., and hold a current DBS certificate.

I will work alongside you flexibly, using my range of skills as appropriate. My role is to support you to make the changes you choose. Your role is to identify the changes you want to make, and to take responsibility for putting what you learn into practice. I am used to working with all sorts of different health and other issues.

Please tell me any medical or other information you feel I need to know in order to work with you safely and effectively, and update me on any relevant changes while we are working together. I am not medically trained; please always consult your doctor on medical issues.

Your first session will usually be 1.5 hours (£90).

After that sessions will usually be one hour (£65)

Or you can book 3 sessions (1.5 hours plus 2 x 1 hour) in advance (£200)

Cancellation of appointments

Please give me at least 24 hours notice of any cancellation to avoid paying for the session.

Confidentiality

Sessions are private and confidential. There are two exceptions to this;

My own supervision sessions, where you will not be identified by name, and other details will remain confidential to the session.
If I feel you are at risk of harming yourself or others, it is my legal responsibility to inform an appropriate person. Where appropriate, I will tell you before doing this.

I take brief notes in sessions to support my work with you, and these are also confidential.

Privacy policy

Please see my website for details of my privacy policy. In summary, I am committed to keep your data secure and private in accordance with the law. I will never sell or pass on your data without your permission. I will only send you information that you have agreed to receive. You may remove yourself from any newsletter or email mailing list at any point by unsubscribing. I am Registered with the ICO for Data Protection

Name*

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone

Email*

Date of Birth*

day

month

year

Occupation

What’s the main issue you are looking for help with?*

When did it start?*

What do you want instead?*

Are there medical issues it would be useful for me to know about? *

Are you on any medication currently?*

To receive Pippa’s VERY occasional emails with upcoming events or news please select Yes or No*

To receive the Get Change Team monthly Top Tips newsletter please select Yes or No*

Signed by:

First

Last

Date of signing:

*Clients may give consent under the Data Protection Act from the age of 13. Under that age parental consent is required and normally I would ask for a parent or appropriate adult to be present in the session, unless both parent and child want the child to see me separately.