Coaching Questionnaire

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I 'm Ready To Say Yes!

First Name

Last Name

Phone

This group is a very sacred container. I accept applicants who are ready to rise up, and see themselves in a very clear way. This means you may feel triggered at times. This means you may be asked to explore parts of you that are hard to look at. This will require you to dig deep and with that, sometimes growth can be challenging and intense. Does this feel aligned?

Yes, I am ready!

Not today.

What does personal responsibility and personal accountability mean to you?

What are you hoping to get out of this coaching container?

What is getting in the way of your healing?

How would you describe your current self in 3-5 words?

If someone hurts you, intentionally or unintentionally, how do you respond/react?

How do you handle disagreements?

If I could change three things about my life/situation, they would be:

The one thing I wish I could change in the short-term is:

What goals do you want to achieve in the next 6 weeks?

Where are you now in your healing?

Which one sounds most like you?

"I feel overwhelmed a lot. I always feel like I have so much to do and I never know what to do first so I end up doing nothing."

"I feel like I don't have much energy. I don't really want to do anything. I like lounging. I'm not very social. I prefer to be alone."

"I really like the company of others. I feel anxious, angry, or irritable a lot of the time. I feel overwhelmed sometimes. I want to know what I need to do to feel better!"

"I feel calm. I have a good balance of energy. I feel productive a lot of the time. I feel safe to come and go into and out of connection with others. I know what is expected of me, and I understand my own internal limits."

The financial commitment of this program is $1300.00 (with payment plans available). Do you feel ready to make this investment? There is no wrong answer.

Without a doubt!

I don't have the money right now.

I can try to make this happen, but the commitment feels big.

Do you feel ready to commit energetically, emotionally, and financially?

Absolutely!

Not right now.

Is there anything else you'd like me to know?

Do you have any questions for me?

Thanks for submitting!

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