Name
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First Name
Last Name
Email
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What are three challenges in that you want to immediately address? Please be as specific as possible.
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What outcome(s) do you wish to achieve through coaching?
Are you undergoing (or have you undergone) psychotherapy or medical treatment? If so, please share any details you consider relevant.
What do you find most pleasurable in life?
What do you like most about yourself?
What behaviours or habits of mind would you most like to overcome?
On average, how often do you feel anxious, worried or uncertain?
On average, how often do you feel sad, lonely or depressed?
How often do you feel happy, calm and satisfied?
Identify three traumatic life events.
These could be anything from a near-death experience to witnessing an accident. They could also be seemingly small events, like feeling humiliated in front of colleagues or failing an exam.
Please use this area to share anything else you would like to share.
