1:1 NEW Client Registration Form (Coaching/Consulting 2024/5) | Webform Portal

1:1 Registration Form

This form takes about 10–15 minutes to complete. You’re welcome to take your time, and only share what feels right for you right now. There are no right or wrong answers here. This is a chance for you to be seen, supported, and understood.

This helps you reflect and gives me a starting point to understand where you’re at and what matters most to you.

Contact/Booking Information & Preferences

Full Name: *

Email address for booking confirmations *

Gender: *

Which age range do you fall into? *

Mobile Telephone Number:

How do you prefer to communicate? *

WhatsApp (chat or voice notes) Messenger (Facebook) Voxer (Voice or chat messages) Email Other

Contact preferences: *

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Imagining Change (Big or Small)

Do you have a vision—or even a small sense—of the kind of change you’d love to see in your life and/or in the world? *

Are there any values or themes you want to live by more fully (e.g., freedom, connection, creativity, purpose)? *

What You’d Like Me to Know About You and Your Health & Wellbeing

What is your employment situation? *

Are there any health or wellbeing factors you'd like me to be aware of that could affect how we work together? (Optional – only share what feels relevant and safe for you)

Please include any specific details

Have you received an official diagnosis?

If yes, please provide details

How clear are you about the barriers you face when you're trying to make decisions or progress towards taking action? (This could be things like fear, fatigue, overwhelm, systems, people, technology, terminology etc.) if known?

If you’d like to add more detail, feel free to share below:

Working Together in a Way That Works for You

What areas would you like to focus on in our sessions? *

What would be the best outcome for our time together? *

Which of these types of support have worked well for you in the past? (tick any that apply, or add your own) *

Gentle encouragement Clear structure or steps Time to reflect Talking things through Writing or journaling Visual aids or examples Accountability check-ins Something else (please share)

Have you found any types of support, communication styles, or environments that helped you feel seen, heard, or able to make progress in the past? (This could include things like check-ins, flexible pacing, visuals, body doubling, routines, etc.) *

How would you describe your preferred pace for our work together? (It’s okay if this changes over time) *

need things to move gently and gradually prefer a steady structured pace I like to dive in and explore deeply My energy levels fluctuate — I’ll need flexibility I’m not sure yet Other (please share)

How do you prefer to give feedback? What helps you feel safe to be honest? *

After some time to reflect With prompts or specific questions In the moment Verbally In Writing I find it hard to give feedback but I'd like to find a way Other (Please share)

Is there anything else you'd like me to know before we begin? (This could be something that hasn’t been asked, a heads-up about how you're feeling, or anything on your mind.)

How would you like to attend your sessions? *

Preferred Platform for Online Sessions *

Session Frequency: *

Your availability? *

Weekdays 8AM-12PM Weekdays 1PM-4PM

Session Recordings

Please be aware that all sessions are recorded (audio and transcribed) to support my own disability and for training and monitoring purposes. If you would like access to listen or read back, please let Michelle know before or during the session.

Data Protection

Michelle Shaw operates in full compliance with the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. We will only collect, store, and process personal data:

Fairly, lawfully, and transparently.
For specified and explicit purposes.
In a way that is adequate, relevant, and limited to what is necessary.
Accurate and, where required, kept up to date.
Retained only for as long as necessary.
Ensured with appropriate security measures, including protection against unauthorised or unlawful processing, accidental loss, destruction, or damage.

If, at any point, you would like to request a copy of the data we hold about you or wish to have your data deleted, please contact us at: info@michelleshaw.co.uk.

SAFEGUARDING

Safeguarding and Ethical Boundaries

Michelle Shaw is committed to safeguarding and promoting the welfare of all individuals we work with. Both the coach and client agree to uphold the following safeguarding measures and boundaries to ensure a safe, ethical, and supportive coaching environment:

Respect: Both parties agree to treat each other with respect at all times, both inside and outside coaching sessions.
Confidentiality: All personal information shared in coaching sessions remains confidential, except where required by law or where there is a serious risk of harm to the client or others. Mischemix takes confidentiality seriously and ensures that all information is handled with care and respect.
Harassment and Discrimination: Any form of harassment, abuse, discrimination, or unethical behaviour is strictly prohibited. This includes, but is not limited to, inappropriate language, actions, or behaviour that undermines the integrity of the coaching relationship.
Emotional Safety: Both the coach and client must be mindful of each other’s emotional well-being. The client must feel safe to express themselves, and the coach must ensure that any feedback or conversation is conducted in a supportive and respectful manner.
Culture of Safety: Michelle Shaw actively promotes a culture of safety and protection for all individuals involved. We take all safeguarding concerns seriously and address them promptly in line with safeguarding policies and procedures.
Trained and Responsible: All staff and associates are appropriately trained and aware of their safeguarding responsibilities to ensure safe working environments, both online and in person, protecting individuals from harm, abuse, or exploitation.
Best Interests: Michelle Shaw is dedicated to acting in the best interest of all individuals, maintaining clear communication and appropriate boundaries, and ensuring that support is available when needed.

If you have any safeguarding concerns or questions, please contact us at info@michelleshaw.co.uk.

I agree to attend my confirmed sessions or notify Michelle as early as possible if I’m unable to attend. *

I agree to help Michelle by providing feedback or my experience in some way. *

If I find the service helpful, I agree to provide a testimonial upon completing my final session *

I confirm that the information provided in this form is true, complete, and accurate. *

I consent to Michelle retaining my information to contact me about sessions or follow-up communications. *

I would like to stay informed about future sessions, courses, and opportunities relevant to me *

Attendee Signature: *

Tap or click on the signature area above to sign.
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