Please fill out this intake form to provide more information about yourself!
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Coaching is the universal language of change and learning "

 
Name

 
Email

 
Phone Number

 
Birthday

 
Mailing Address

 
Preferred Method of contact between sessions?


 
Marital Status


 
Tell me about your education

Did you go to college, currently in college, getting ready to graduate? Are you happy with your level of education? How confident are you with your major and resulted job prospects or opportunities?
 
Work/ Occupation

What do you do for a living? Do you work part-time or full-time?
 
Have you worked with a coach or a mental health provider before?

 
On a scale from 1-10 (10 being super-duper) how are you feeling about life right now?











 
In terms of where you imagined yourself being, on a scale of 1-10 (10 being highly successful) How would you rate where you are in life right now.











 
If there were no obstacles in the way, what dream would you like to make happen?

 
Think about one or two people you know who inspire you. What is inspiring about them?

 
What parts of your current job or life activities do you enjoy the most?

 
What two steps could you take immediately that would make the biggest difference in your current situation?

 
How have you been motivated in the past to reach difficult , make difficult decisions, or do challenging things? How can we best utilize that motivator now?

 
Do you give your power away? When and to whom?

 
What do I need to know about you that will help me most in coaching you?

 
Thank you so much for signing up for coaching sessions. Please allow me at least 48 hours to process your form and I will respond with an email to set up your sessions.

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