You can always press Enter⏎ to continue
Young Persons Self Assessment

Young Persons Self Assessment

Hello. I am so excited to be working with you so that you can become the most awesome and incredible version of you. I would be really grateful if you can spend some time completing this form so I can get to know you better. I already believe you are amazing, gifted and talented but I want you to believe that too and working together  I know you will be incredible.
30Questions
  • 1
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 5
    What is the trigger means, what is going on before to experience the issue, what are you thinking or is someone else triggering you?
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 6
    1 of 10
    Press
    Enter
  • 7
    A symptom is once you have been triggered what are you feeling, think about how your body feels for example you shake or feel sick?
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 8
    What is your habit or behaviour means how do you respond when you are triggered and feel a certain way for example do you shout at someone or hide away?
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    E.G. I get nervous when when i am about to sit a test, i feel like i am being judge, i don't feel like i belong.
    Press
    Enter
  • 11
    What do they stop you from doing? 
    Press
    Enter
  • 12
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Feel great
    Intense negative feeling
    Press
    Enter
  • 16
    1 is not motivated at all, 10 highly motivated and willing for change to happen.
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 17
    On a scale on 0 - 10, 0 strongly disagree, 10 = Strongly agree
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 18
    On a scale on 0 - 10, 0 strongly disagree, 10 = Strongly agree
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 19
    On a scale on 0 - 10, 0 strongly disagree, 10 = Strongly agree.
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 20
    On a scale on 0 - 10, 0 strongly disagree, 10 = Strongly agree.
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 21
    On a scale on 0 - 10, 0 strongly disagree, 10 = Strongly agree.
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    Not al All
    Highly motivated
    Press
    Enter
  • 22
    Think about what your life would be like if you did not have the issue/s. Be descriptive and imagine being the best version of you and how you would look, what you would be doing more of etc.
    Press
    Enter
  • 23
    e.g. Imagine your mind is like a giant computer and when you type a question in it to ask your brilliant genius mind the root cause and reason for your issue what would you like to ask for example Why do always feel anxious around other people?
    Press
    Enter
  • 24
    If you could wake up tomorrow without the issue, what would you be doing differently?
    Press
    Enter
  • 25
    List 5 things of what would happen if you did have what you want for example What would happen if you had unstoppable confidence? 1. Feel happy 2. Speak to more people 3. Go out more 4. Sign up for new classes 5. go to new places etc....
    Press
    Enter
  • 26
    Now list 5 things of what WOULDN'T happen if you did have eg confidence 1. My mum wouldn't keep checking on me 2. My friends wouldn't talk to me and ask if I am ok 3. my teachers wouldn't give me any attention and check on me etc....
    Press
    Enter
  • 27
    Now list 5 things of what WOULD happen if you DIDN'T have eg confidence 1. My mum checks on me all the time 2. My friends speak to me and worry about 3. My teachers always check on me and I get to go out of class. (If you can't think of all 5, make sure you come up with 3 answers.
    Press
    Enter
  • 28
    Now list 5 things of what WOULDN'T happen if you DIDN'T have eg confidence 1. I wouldn't go out much 2. My friends wouldn't ask me to go out because I don' speak much 3. My teachers wouldn't leave me to get on with my work and give me more because they think i am not capable
    Press
    Enter
  • 29
    Press
    Enter
  • 30
    Imagine money was no object and you could do anything you wanted to do, what would you love to do and be?
    Press
    Enter
  • 31
    Press
    Enter
  • 32
    Press
    Enter
  • 33
    Only select the 1 that is most important to you
    Press
    Enter
  • 34
    Only select the 1 that is most important to you
    Press
    Enter
  • 35
    Only select the 1 that is most important to you
    Press
    Enter
  • 36
    Only select the 1 that is most important to you
    Press
    Enter
  • 37
    Only select the 1 that is most important to you
    Press
    Enter
  • 38
    Only select the 1 that is most important to you
    Press
    Enter
  • 39
    Only select the 1 that is most important to you
    Press
    Enter
  • 40
    Only select the 1 that is most important to you
    Press
    Enter
  • 41
    It is not essential to watch and i will be going over this with you but can be very helpful for you. https://www.youtube.com/watch?v=zCv-ZBy6_yU
    Press
    Enter
  • 42

    Young Persons Terms and conditions, Policy and Privacy guidelines

    PLEASE READ AND SHARE WITH YOUR PARENTS ANYTHING YOU DO NOT UNDERSTAND

    I am looking forward to working with you and before we work together please make yourself familiar with the guidelines of our work together.

    What do I do?


    I, Claire Linturn am a Rapid Transformation Therapist, Clinical Hypnotherapist. I own a private practise and one of my areas of expertise is working with children, young
    people and their families to help people better understand how they think, feel and behave.

    Our work together is a partnership and you will be required to follow my guidelines as we work through them. Should you choose not to your treatment may be compromised.

    Confidentiality

    Your sessions will be confidential, however I will ask if you would like to share the information with a parent/guardian or the teachers as this can be very helpful for you to overcome your issue and help them support you more fully.

    As a professional I am legally bound to disclose any information if you are at risk of harm by a person or yourself including sexual abuse and self harming. This will be reported to your parent/guardian, doctor, external agency and if working within a school directly to the safeguarding officer who will follow their own procedures. This is not a definative list and I recommend this link if you require further understanding and speak with your parent for more understanding. It is also a wonderful resource to assit you for overcoming your challenges. https://youngminds.org.uk/about-us/

    Personal Data

    As an essential part of my work, I collect some of your personal information, for
    example, your name, address, your school, and other details. I understand that you
    share very personal and at times, highly sensitive information with me when I work with
    you, and so I know, that it’s really important for that information to be kept very safe.

    What Information do I collect?


    This includes your name, home address, email address, telephone and other contact
    numbers and school information.I collect this in a number of different ways. For
    example, this data may be given to us directly online or over the telephone, or when
    corresponding with me by letter. During our session I make notes in your words and you may request to see them.

    How do I keep your information safe?


    I take my data security responsibilities very seriously and follow the UK data protection rules and laws.

    All our information is stored very safely and I have strict rules around the technical
    systems I use, how it is accessed and by whom. I make sure that your personal
    information is held in a place that is not accessible by the public, and I have rules to
    guard against improper use and accidental loss of data.


    Can I see the information about me that you keep?


    I have written this privacy notice which describes the ways in which I collect, manage, process, store and share information about you as a result of you visiting my website or working with me. The privacy notice also provides you with information about how you can have control over the use of your data. You can find the policy on my website www.creativecoachingtherapy.co.uk/contact.

    Under the General Data Protection Regulations (May 2018), you can ask to look at, change or delete personal information that we have on you. You can do this by sending an email to the creativecoaching@outlook.com.

    What to expect during a session/s with Claire Linturn?

    You may experience some abreactions (an abreaction is an emotional response), such a crying, laughing, coughing, yawning and everyone is different to how they respond. This is an important part of the process as it releases any negative responses you have been experiencing.

    Change happens very differently for each person. During the session you will experience a change however for a new pattern of behaviour of feeling to change some people notice it over a period of time or they may realise later on they are doing something they would not have done before.

    It really is very important you commit to listening to the recordings and any additional work provided.

    Press
    Enter
  • 43
    Press
    Enter
  • 44
    Press
    Enter
  • 45
    Press
    Enter
  • 46

    Thank you for answering these questions to gain a great understanding about you. I am excited to be working with you and together we can overcome your challenges and unleash the potential i already know you have. Lets find it together and make life this exciting adventure that we have all been born to have.

    You are already amazing, now its your turn to truly believe it!

    'If you always do what you have always done, then you get what you always got'. What's exciting is that you can change it and make things happen.

    Press
    Enter
  • Should be Empty:
Question Label
1 of 46See AllGo Back
close