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* 1. Your name

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* 2. Your email address and telephone number(s)

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* 3. What roles do you have ?

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* 4. Stage in your career & professional bodies

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* 5. Briefly outline what you hope to get from this group coaching.

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* 6. If you have a particular problem, dilemma or project you want to work on please give brief details. 

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* 7. What would be your preference for how to meet?

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* 8. Please tick in order of preference all the times you are available for regular supervision

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* 9. If you cannot make any of the times above please give an idea of your availability.

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* 10. How did you hear about us?

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