Book a Session | Gentle Steps Recovery Coaching

Your intake form

Tell us about yourself

Answer as openly as you feel comfortable. There are no right or wrong answers here.

1. What's your name? *

2. How old are you? *

3. Where are you based? *

4. What type of addiction or behaviour are you dealing with? *

5. How long have you been dealing with this? *

6. How would you describe where you are right now? *

7. Have you tried to quit or reduce before?

8. Which areas of your life has this affected most? *

9. Do you have any support around you right now?

10. What made you decide to reach out right now?

11. What do you most want from coaching? *

12. How would you prefer to have your sessions?

13. Is there anything else you'd like Moses to know before your first session?

Finally — what's the best email to reach you on? *

🔒 Everything you share is completely confidential. Moses will be in touch within 24 hours.