This form is not a test, and there are no right answers. Share only what feels safe for you today. Your responses help me understand how to best support you.
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Question 1 of 13
What is your full name?
Question 2 of 13
Email address
Question 3 of 13
Phone number (optional)
Question 4 of 13
Where are you currently located? (city, state, country)
Question 5 of 13
What prompted you to reach out for coaching right now?
Question 6 of 13
What feels most unresolved, tender, or heavy for you right now?
Question 7 of 13
What are you hoping coaching might help you with?
Question 8 of 13
If this work were supportive in the way you need, what might feel different by the end of our time together?
Question 9 of 13
Are you currently working with a therapist, counselor, or mental health provider?
Yes
No
I have in the past
Question 10 of 13
Are there any diagnoses, life circumstances, or current stressors that feel important for me to know about?
Question 11 of 13
What feels important for you to receive from a coach in order to feel safe and supported?
Question 12 of 13
Is there anything you’re hoping this coaching will not feel like?
Question 13 of 13
Is there anything else you’d like me to know about you or your story?