Intake & Payment - Awaken Inner Sense

Instructions for Client:

Section 1: Professional Background & Identification

Name

First

Last

Email

Please enter your email, so I can follow up with you.

Telephone Number

Age

Location and Time Zone

Emergency Contact (Name & Number): (Required for safety protocols)

Section 2: The Gateway: Which coaching pathway are you seeking to enter?

Neuro-Somatic Energy Coaching (Blueprint) - High-level regulation, nervous system rewiring, and energetic field alignment for peak performance.)
Neuro-Somatic Hormonal Energy Coaching (Rebirth) - A sophisticated blend of endocrine health, neuro-somatic tools, and energy psychology for metabolic and hormonal peace.)

Section 3: The Deep Dive

Readiness Scale:

Number Slider

Selected Value: 0

Section 4: Your Somatic Story & Support Ecosystem

The Somatic Narrative:

Current Support Team:

Healing & Development History:

Section 5: Hormonal & Metabolic Focus

Bio-Markers: Are there specific hormonal or metabolic concerns you are currently navigating? (e.g., Thyroid issues, PCOS, Perimenopause, Adrenal Fatigue, Chronic Fatigue Syndrome, or Cycle Irregularities).

Section 6: Safety & Stability Check

Safety Disclaimer: This is a high-level coaching practice, not an emergency crisis line.

Number):

Because this work involves deep somatic and energetic processing, it requires a foundation of current stability. Are you currently navigating an acute crisis or active addiction that requires immediate emergency intervention?

No, my system is currently stable enough to engage in deep, transformative work.
Yes, I am currently navigating an acute mental health crisis. (If selected, please get in touch with emergency services as this coaching container is not a substitute for crisis intervention).

Section 7: Alignment, Investment & Legal Consent

Pathway Investment Confirmation:

Professional Coaching Assessment (90-minutes): £550 (This mandatory assessment maps your nervous system and determines your bespoke coaching roadmap.)

Terms of Engagement & Coaching Container Policy:

1. The Fixed Container Policy:

2. Financial Commitment:

3. Ending the Work (The Closing Phase):

4. Communication Boundaries:

5. Professional Ethics & Privacy:

Practice Boundaries & Consent: (Please check all to confirm)

Container Commitment: I understand that this practice is dedicated to deep, multidimensional energy coaching containers rather than short-term 'check-in' sessions.
Financial Commitment & Policy: I acknowledge that all fees are paid in full to secure my placement in the diary. I understand that for all assessments and container sessions, there is a strict no-refund, no-cancellation, and no-postponement policy. Once a session is booked, the time is dedicated exclusively to my clinical work and cannot be moved or refunded.
Medical Non-Advice Disclaimer: I understand that Neuro-Somatic Energy Coaching is not a substitute for professional medical advice, diagnosis, or treatment. I acknowledge that this is a coaching relationship and not a medical or clinical endocrine service.
Environmental Consent: I commit to being in a private, quiet, and safe space for my 90-minute assessment, where I can move or sit comfortably and speak freely without interruption.
Investment Readiness: I am ready to commit to a premium, specialised coaching container and have the resources to invest at this level of depth.
Acknowledgement: By proceeding with your booking and payment, you are agreeing to enter this coaching container under these terms. You are acknowledging that this structure is in place to support your highest level of performance and transformation.

Section 8: Final Submission

Date

GDPR Agreement