Worksheet

Apply to work privately with Chalisa Morrison

Please fill out the form below to work privately with me to thrive in life and love. While I would love to be able to help every person in the world, this is simply not possible. Still, I do read each application carefully, and I personally reply to everyone who applies.

Know that I only take on a certain number of clients at any given time to ensure that I can provide a high level of comprehensive support to those individuals or couples. If I can't support you immediately, that doesn't mean that I won't support you in the future.

Please know that your privacy is important to me and I will treat your confidential information with great care and respect.

Thanks for your patience - I look forward to supporting you.

1. ➜

Date

2. ➜

Name

3. ➜

Email

4. ➜

Phone

5. ➜

Please tick whether you are applying as an individual or couple

Individual

Couple

6. ➜

Partner's name - if applying as couple

7. ➜

Partner's email - if applying as couple

8. ➜

Please tick that you understand:

Chalisa doesn't work in the areas of domestic violence, clinical psychology or addictions

Medicare & Private health fund rebates are not available for Chalisa's services

9. ➜

Tick the relevant areas of support that best match what you are looking for:

Life Coaching

Couples Therapy

Relationship Coaching

Healing

Personal Development

Managing Emotions

Communication Skills

10. ➜

Please describe your top 5 challenges that your are currently experiencing:

11. ➜

If you were to work with me, what would be an amazing outcome?

12. ➜

Please tick your preferred appointment types

The biggest benefit of Online Zoom appointments is that sessions can be recorded for you to download; enabling you to refer back to the recording content for reference and to continue to develop the tools and practices we cover.

Online Zoom only

In-person at Torquay, VIC only

Online Zoom and In-person at Torquay

13. ➜

Have you completed any of my online programs?

Yes

14. ➜

If you have ticked 'yes' above, please tick which online programs you have completed / started:

Starter Kit

Love Guide

Connecting To Self Introduction

Inner Union Fundamentals

Relationship Fundamentals

15. ➜

Are you willing to:

Be open-minded

Step outside of your comfort zone

Take responsibility for your own progress

Take action daily to create different outcomes

Be the best version of your 'Self'

16. ➜

Can you afford to work with me?

I charge $280 p/hour for one-off sessions and programs are charged from $220 /hr

Yes

17. ➜

What sessions are you most interested in?

I prefer going on a transformational journey with clients and offer reduced rates for Programs (a series of sessions customised to clients needs and desired outcomes).

One off - 60minute Coaching & Therapy Session

One off - 90minute Couples Communication & Boundaries Break Through Session

3-7 hour program customised to our needs

18. ➜

Are you a student, unemployed or on sickness leave?

Please let me know here:

19. ➜

Is their anything else you want to say?

20. ➜

I would love to hear about how you heard about me and my work (if you can spare the time)

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