Intake Form Question Title * 1. Contentment 1 - I never feel happy or content, every day is a struggle 10 - I always feel happy and content. I rarely struggle. Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 2. Feelings about the future 1 - I don't feel optimistic about the future 10 - I feel very optimistic about the future Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 3. Closeness in relationships 1 - I haven't been feeling close to other people lately 10 - I have great relationships and feel close to other people Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 4. Clarity 1 - I have not been thinking clearly lately 10 - I feel very calm and clear-minded Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 5. Self-worth 1 - I do not feel good enough 10 - I feel good enough Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 6. Beliefs and judgements 1 - Beliefs and judgements are important and I take them seriously 10 - I don't take my beliefs and judgements too seriously Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. DISCLAIMER: Mental Wellbeing In Schools practitioners are wellbeing educators. While I understand that coaching is a potentially life-changing experience, I also accept that I remain responsible for my choices, actions, thoughts and feelings throughout and beyond the coaching process. I will not, under any circumstances, hold Edward Anthony or Mental Wellbeing In Schools liable for any loss or damage that occurs as a direct or indirect result of the services provided by Mental Wellbeing In Schools or Edward Anthony. I understand that Edward Anthony is not a trained mental health professional and that I am taking part in coaching sessions, not psychotherapy or counselling sessions. I confirm that I have read and understood the above disclaimer, and agree to be coached under all terms and conditions set out by Mental Wellbeing In Schools. Question Title * 8. Contact Information Name Email Address Phone Number Done