CoachIntakeForm

Become a Psyberanima Coach

Join the world's first Cyberpsychology Coaching Platform. Please fill out this intake form so we can match you with the right clients.

Full Name

Email Address

LinkedIn Profile URL

Primary Qualification

Qualification Details (Year & Institution)

Mentorship / CPD Status

Coaching Specialisms (Hold Ctrl/Cmd to select multiple)

Target Audience Match

Coaching Style

Standard Hourly Rate (GBP)

Availability Windows (Select all that apply)

I am interested in running Group Accountability Pods (Scalable Income)

Short Bio (For Client Matching)

I confirm I hold Professional Indemnity Insurance valid for Coaching/Training. *

Non-Clinical Agreement: I understand Psyberanima is a performance coaching platform. I agree to refer clients needing clinical therapy to appropriate medical services. *

I agree to the Coach Terms and Privacy Notice. *

Success! Your coaching application has been received.