JessiEly.coach Intake Assessment
Hello & welcome! I'm so excited that you've arrived here because it means that you're interested in learning about yourself and growing through life coaching. Thanks in advance for taking the time to answer the following questions so that I have a better idea about how I can most effectively serve you. We'll explore & dig into your answers together during our first few sessions.
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Email *
Name *
Cell phone number (I pinky promise to NEVER call you)
Mailing address (not required, but I do love to send love notes in the mail occasionally)
Emergency contact name & phone number *
Pre-Work Questions
These questions will help identify and increase awareness around some of your current thoughts and feelings. None of the questions require an answer, but I would encourage you to answer as many of them as your time permits. There are no wrong answers, and the answers you do provide (along with anything we discuss during our sessions) will remain totally confidential.
Why are you interested in coaching or what do you hope to accomplish by being coached?
Do you feel you will achieve your desire results? Why or why not?
Are you willing to try all the exercises and homework? (Especially the ones you feel resistance to?)
What is the thing you most want to change in your life?
What are you willing to sacrifice to change your life?
What are you NOT willing to sacrifice to change your life?
Would anyone in your life be upset if you changed? If so, who? Why do you think they might be upset?
What will happen if you don't change? What will it cost you?
What is the most upsetting issue pressing on you now?
What gives your life meaning?
Do you believe you are living the life you are meant to live? Why or why not?
What do you want other people to know about you?
Thanks again!!
By submitting this form, you are agreeing to be contacted via email about life coaching with Jessi Ely. We'll start with a complimentary Mini Session, and then go from there! Talk to you soon!
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