Your Welcome Form - Eggshell Therapy and Coaching

Hi! First of all, thank you for being in touch, and I am delighted that we will be working together.

Before we start, here are a few things I would need from you.

1. Please review the Working Agreement before proceeding. Unless you prefer a physical contract, the submission of the Welcome Form will serve as an electronic signature for your consent to the terms of the Working Agreement.

2. Please fill in the Welcome Form. The information you provide is confidential. There are some compulsory fields, and I would need at least one emergency contact from you. But otherwise, if you have concerns about the relevance of any information and wish to leave it out, please feel free to do so. You can also refer to the Privacy Policy to see how your details will be handled.

3. Please settle the payment for your session 24 hours in advance of the scheduled time. The payment policies and account details are included in the Booking Confirmation email and the Working Agreement.

Any questions, please do not hesitate to ask. I could be reached at imi@eggshelltherapy.com

I very much look forward to starting this journey with you!

Imi

Name *

First

Last

Phone Number *

(Please include the area code)

Postal Address *

Email *

Emergency Contact and Your Relationship to Them *

Please provide at least one phone number.

Medical Contact (GP or Psychiatrist) *

Birthdate

What are the areas or issues that you would like us to work on?

So far in your life, what have significantly influenced, inspired, or supported you?

Can be past experiences, books, websites, people or any other resources you could think of.

Any other information you would like to let me know, or that I should be aware of?

Any particular sensitivities, medical history or risk factors.

I agree to the Working Agreement, which could be found at: eggshelltherapy.com/agreement. *

I understand and agree that you will hold and process the information that I have provided in accordance with your privacy policy, which could be found at: eggshelltherapy.com/privacy. *

I understand and agree that you will be communicating with me through the contact details I have provided. *

Signature *

You can just type your name

Message

Imi Lo

Book a Session with Imi | Website

Imi Lo is an independent consultant who has dedicated her career to helping emotionally intense and highly sensitive people turn their depth into strength. Her three books, Emotional Sensitivity and Intensity, The Gift of Intensity, and The Gift of Empathy, are translated into multiple languages.
Imi holds three master's degrees in Mental Health, Buddhist Studies, and Global Cultures, alongside training in philosophical counseling, Jungian psychology, and other modalities. Her multicultural perspective has been enriched by living and working across the UK, Australia, and Asia, including with organizations such as Médecins Sans Frontières/Doctors Without Borders and the NHS (UK). Throughout her career, she has served as a psychotherapist, art therapist, suicide crisis social worker, mental health supervisor, and trainer for mental health professionals.
You can contact Imi for a one-to-one consulting session tailored to your specific needs.