COACHING INTAKE FORM
Welcome to HEAL - a 1:1 coaching program! So excited to be joining you on your journey and the next 8-12 weeks is going to be transformational, fill out the form below at least 24 hours before your first session and get in touch via email if you have any questions.
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Name + your preferred pronouns *
Email Address *
Age *
Emergency Contact (name + phone number) + who are your go-to support people in your life, elaborate on what your relationship is like with them. Please confirm I have your permission to contact these people in the case of an emergency. *
Why are you signing up for coaching NOW? Was there a specific event or circumstance that led you to this point? *
If you could narrow it down to up to 3 desired outcomes from coaching, what would they be and why? *
On a scale of 1-10, how intense do the challenges feel that are bringing you to sign-up for coaching? *
Very intense, really interrupting my day to day life.
Don't affect me at all
On a scale of 1-10, 10 being the person you actually want to BE in the world (your most authentic self) where do you feel you currently are on this journey? *
My most inauthentic self, wearing a mask, showing up as anyone but myself.
Showing up as my god damn amazing self every day!
Are there any fears/concerns or questions you have so far about coaching? Let's address them together. *
Please tick to confirm you agree & acknowledge the following T&C's *
Required
Please tick to you have completed the following at least 24 hours before your first coaching call (call will need to be rescheduled if not). *
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