PHC Coaching Registration Form

Directions:
To schedule an initial PHC coaching evaluation, please complete the following form prior to your first coaching session. 


Please note, PHC coaching is not designed to address mental health difficulties. Professional coaching is designed to assist you in achieving success in the workplace. It is not psychotherapy, and, as your professional coach, Dr. Jenkins is not serving in the role of a clinical psychologist. If you are a professional seeking psychotherapy, please do not submit this form. Please contact Dr. Jenkins directly at (813) 494-9526.

If you are experiencing a life-threatening emergency, please call 911 or present immediately to the nearest emergency room.
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Occupation
Practice Type
Leadership Role:
Type of Coaching Requested: (select all that apply)
Coaching Focus:
How were you referred to PHC for coaching? (select all that apply)
Is your coaching a requirement for your professional role?

Thank you for registering for the PHC Coaching Program with Dr. Jenkins. Please feel free to contact us by phone if needed. We will be in touch soon.

Professional Health Consulting
6706 N Nebraska Ave #9765

Tampa, FL 33674

(813) 494-9526

ProfessionalHealthConsulting@gmail.com
ProfessionalHealthcConsulting.com