First Name *

Last Name *

Email (where I will send your confirmation email) *

Contact Number (to confirm our schedule) *

What inspired you to seek coaching at this particular time in your life? *

On a scale of 1-5, how ready and committed are you to investing time and energy to create change in your life? (1 = Not ready at all, 5 = 100% ready and committed)

Is there anything else you feel is important for me to know about you, your history, or your situation before we begin our first session?

Agreements

To ensure we start our coaching relationship with clarity and mutual understanding, please read and acknowledge the following statements.

Coaching vs. Therapy Disclaimer: I understand that coaching is a partnership that supports personal and professional growth. It is not a substitute for therapy, medical advice, or professional mental health care. As a coach, Ness does not diagnose or treat any medical or psychological conditions.

Confidentiality: I understand that everything discussed in our coaching sessions is confidential. The only exceptions are if I express intent to harm myself or others, in which case the coach may be required by law to report it.

I have read and I understand this statement.

Thank you for completing the form. Once you hit submit, you will be directed to the secure payment and scheduling page to finalize your booking.

I am genuinely looking forward to connecting with you soon.