Introductory Form
Please take a moment to fill up these details. Do not worry. All details that you share with us are confidential, and are strictly for our records. The only exception when information will have to be divulged is in case of threat to life (yours or another) or a legal case.
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Name: *
Email ID: *
Contact Number: *
Address: *
Occupation: *
Age: *
Birthday: *
Anniversary:
Referred by:
What goal/s do you wish to achieve upon working together? Try to be specific. Example: Overcoming Anxiety, Becoming Fitter, Improving Communication, etc) *
Before contacting us, have you tried to other ways of achieving your goal/ resolving your problems? If yes, how? *
Would you like to opt for a single session / fewer sessions to achieve your goals, or would you prefer a longer term association? (Please note that this question is to understand your preference, and the number of sessions will be recommended by the professional) *
Have you worked with a Coach, Therapist or Counsellor before? *
Name and contact number of the person to call in case of an emergency: *
Would you like to receive updates on workshops, free seminars and other activities that we conduct from time to time? *
If yes, how would you like to be informed? *
Required
I have read the Policy and Important Guidelines document (https://refindyou.com/company-policy/) and I am willing to abide by them. *
I accept the cancellation policy as stated in the Policy and Important Guidelines Document (50% charge if rescheduled/cancelled within 24 hours of the appointment, 100% charge in case of no show, or cancellation within 2 hours of appointment time) *
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