PRIVATE DOULA COACHING APPLICATION 
Thank you for taking the time to apply for private Doula coaching.  Please take 10 minutes to answer the questions below as openly and honestly as possible. This will allow me to get to know you better, and also ensure that I can support you at this time.


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Name

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Email

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How did you find me?

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What has brought you to seek grief and loss support and coaching at this time?


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What type of loss did you experience?

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How long ago did you experience the loss you are seeking help with?

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What is your current emotional state regarding the loss?

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Have you sought help or support for this loss before? If yes, please describe.

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Are you currently taking any medications or receiving any other forms of treatment or therapy? If yes, please describe.

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Are there any specific challenges or struggles that you have experienced during the grieving process?

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Do you have any cultural or religious beliefs that may impact your grieving process or approach to grief and loss coaching?

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How comfortable are you with vulnerability and sharing your emotions with others, including a coach?

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Grief has no timeline. Our  grief support service will help you move forward with your life while grieving, taking things one day at a time with focused attention to grounding you in your life, creating strategies to help with grief bursts and uncovering options to live a balanced and purposeful life after such a loss.

With that in mind, your time with us is scheduled on a monthly basis. You have 5 60-minute sessions per month with daily access via Voxer. We work together according to your specific needs and desires. Everyone is unique!

Is this something you are comfortable committing to? 

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What are your current feelings and emotions surrounding this loss?

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What are your current coping mechanisms for dealing with the loss?

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How has this loss affected your day to day life and activities?

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Is there anything else in your life that may be impacting your ability to grieve or process this loss? (e.g. job stress, relationship changes, financial difficulties)

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What is your understanding of grief and the grieving process?

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How would you describe your self-care routine? Are there any areas you would like to focus on?

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Are there any specific goals or outcomes you would like to achieve through grief and loss coaching and work?

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Your next step is to schedule a free zoom call, so you can learn more about my coaching and I can learn more about you.

Please CLICK HERE to schedule your zoom call.

Once scheduled please mark yes, below and move on to the last question.

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Anything else you would like me to know?

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