Beth's Coaching Intake Form
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Email *
What is your first and last name? *
What is the best phone number to reach you? Is it ok to leave a  message with details at this number, or should I just say "Call Beth"? *
How did you hear about Beth's coaching and workshops? *
What are your top 3 reasons for seeking coaching? *
What are three things you would like to change about your life in the next 3 - 6 months? *
How will your life be impacted when you have fulfilled these desires? *
What will you miss out on, and how will you feel if nothing has changed a year from now? *
What resources, in addition to coaching, can you draw on so that you are bringing everything you have to this growth process? *
What obstacles, if any, could affect your involvement in coaching and meeting your goals? *
What would you like me to do or not do, to honor your experiences with race, gender, culture, economic status, etc. or to help me better understand your identity and best serve you? *
How familiar are you with Nonviolent Communication? *
Beginner
Expert
How familiar are you with Mindfulness? *
Beginner
Expert
Do you understand that coaching  brings out your inherent wisdom and helps you set and achieve goals? Beth can also consult using her expertise in Mindfulness and Nonviolent Communication. However, she is not a psychotherapist and will not diagnose or treat trauma or other mental health issues. *
Thank you for your thoughtful responses! Now let's meet via Zoom. Copy and paste the below url to schedule a time to meet. If this doesn't work for you, please write down 3 days / times that work in the 'other' option. *
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