Coaching Questionnaire
The purpose of this form is for us to discover the vision and value of what you could attain out of our working together. I will reach out to you within 24 hours to take the next step and schedule a call or refer you to someone who can help. 

A few guidelines:

Answer as much or as little as you'd like.
Be as detailed as you'd like, yet don't "stress" about doing this "right."
Our confidentiality begins now. Share freely.
You'll get an email after with your responses.

I'm looking forward to seeing how I can best support you.

Sign in to Google to save your progress. Learn more
Email *
First & last name *
Pronouns (she/her, they/them, etc)
How did you hear about this? Specifically from where or whom? *
What would you like me to know about you? *
If nothing were in the way, what would you most want to achieve in working together?  (Where would you be experiencing satisfaction, meaning, and fulfillment? What goals and dreams would you be attaining?) *
Where are you now in relation to these goals and dreams?  (What is working or not working currently? Where might there be an opportunity for learning, growth, or breakthrough?) *
What are you looking for in the person you choose to work with?  (What would you LOVE to be present in the person you choose to work with? i.e. "I'm looking for someone who... has certain qualities, takes a particular approach, has a specific area of experience, really "gets" a particular context, etc") *
Are you able to afford coaching?  I currently offer a sliding scale with 3 tiers: $200 / $225 / or $250 per month for 2 50-minute coaching sessions.   *
Any questions to see if we are a fit?  Anything else you'd like to say?  
What is your time zone? What is your preferred time to have our call?   *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Hilary Kern. Report Abuse