I am so excited to begin our coaching journey together! Please take a few minutes to complete this form prior to our first session.
Thank you!
Karen

Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What areas would you like to explore while working together?

What will success look like as you make progress in these areas?

What causes you to feel motivated?

What three words describe you at your best?

What three words describe you at your worst?

What thoughts trip you up when you think about taking action and making changes?

How will you know that you are receiving value from working with me?

Have you previously worked in a 1:1 relationship with a counselor, therapist, coach, or mentor?

Yes

No

If yes, what worked well? What did not work well?

Is there anything else you would like to let me know as we begin working with each other?