Australian Institute of Self Development

For Workshop Registration and Consultations
Tel +61 (0)3 97 222 678

New Client Form Instructions

New Client Form

Emailing us your completed form prior to your tele-coaching or personal consultation is optional and will assist you getting profound results more rapidly.
It’s a comprehensive form which some people may find a lot to complete, so just do as much as you are comfortable with.
The instructions below will make it easier.

Click here to obtain your
New Client Form

Click here to view
Melways map

Page 1 is self explanatory.

Page 2 is an emotional life summary up to age 21. Include your age at the time, a brief description of events and how you felt. Remember there is no right or wrong, it just is. If you were told about your birth include that as well and anything else that you can remember. If you don’t remember how you felt just imagine how someone else would have felt in the same situation.

Below are some typical examples.

Eg; Born premature or forceps delivery not sure how I felt probably lonely & afraid.

2 yrs old first day at child care, cried a lot felt sad and anxious.

3yrs old my baby sister was born, felt jealous angry & unloved.

4 yrs old migrated to Australia missed my friends & auntie felt lonely and angry at parents.

5-15 yrs Dad was very authoritarian and often hit me. Felt stupid, guilty, anxious and angry.

8-12 yrs bullied at school felt fear, angry and helpless. 11 yrs old Fell out of a tree broke my right leg.

12 yrs. Mum bought me a second hand uniform for first day at high school. Felt poor, not good enough.

14yrs. My dog Freckles died, (hit by a car) I blamed myself felt guilty, sad & angry.

15yrs. My girlfriend/boyfriend dumped me and went out with my best friend. Felt hurt and sad.

17yrs. Parents separated & injured in car accident (leg knee & head injuries). Sadness, fear & anger

These are only examples, different people in similar events can take on different emotions. Any given event can huge for one person yet have little significance to another.
Remember to keep it simple and brief.

Page 3 each row represents a different goal. This will assist us to focus on what’s most important to you.

Eg 1. What you want

“Have a happy, loving relationship/marriage” or

“Earn $-------- p/a doing what I enjoy” or

“Achieve and maintain my ideal weight of – kg.

How you feel now without it.

Frustrated, sad, angry….

How will you feel when you have it

loved, appreciated, worthy…..

You may also draw a picture which includes a House, a tree, a body of water and a snake. Use a single A4 page, pen or pencil. Allow about 3-5 minutes (we’re not assessing artistic ability!)

Contact us now:

Tel +61 (0)3 97 222 678

Head office

56 Jumping Creek Road Wonga Park
VIC AUSTRALIA 3115

Office hours Monday - Friday 9-30 am to 7-30 pm
Saturday 9-00 am - 12.30 pm
By Appointment

Appointment Cancellation

We request that you agree to give us the courtesy of 48 hours notice of any intention to change or cancel an appointment. The consulting times are heavily booked and other clients waiting on stand-by can be called if you cannot attend.

A cancellation fee will be charged if this courtesy is not extended. If you have a Saturday appointment, cancellation notice is required by close of business on the Wednesday prior to booking date.