Coaching Questionnaire"*" indicates required fieldsStep 1 of 250%Welcome! I can't wait to hear more about what you want to achieve with coaching. Please complete the contact information at the beginning. Beyond, that the additional questions are optional (and can be skipped if you're short on time). That said, these questions are designed not just to give me a deeper understanding of you, but to also help YOU to increase your awareness of yourself. Here's to the journey ahead!Basic InfoName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last What are your pronouns?Email* Google DriveWe use Google to manage documents for your coaching. Will the above email work in Google? Yes NoGmail addressPlease provide a secondary gmail email address that we can share your documents to. Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*ProfessionBirthday MM slash DD slash YYYY Preferred scheduling for coaching sessionsWhich days and times work best for you?What are your top 3 goals?This can be in anything: wellness, career, relationship, creativity, etc.What do you feel like you do really well? What do you have dialed in?What are you struggling with most?How do you want to feel in your life? Let your imagination run wild. Concepts, images and feelings. What do you want?What made you decide to invest in coaching now?What do you hope to get out of coaching? How do you want your life to be different once you've succeeded with coaching?How do you learn best? By listening By talking through something By seeing it written out I'm a visual learner. I love pictures and videos. OtherHow do you like to be supported? Text checkins Email checkins Scheduled coaching sessions Home practices All of the aboveHow much structure do you prefer? I like to take it as it comes. Too much structure overwhelms me. I need a lot of structure to feel confident in the process. I like a mix of structure and responding to the needs of the moment.Whole Body WellnessWhat is your relationship with food and eating like? How does it relate to your overall wellbeing?How many hours per week do you work (including out-of-office email and texting)?How do you feel about your job (choose as many as you want, even if they’re contradictory)? I love it! It’s exhausting I hate it! I don't know what I want I’m excited about the future I’m at a really good point right now I’m working hard to get somewhere better How many times per day do you check your email?How many times per day do you check your phone?How does your work relate to your wellness?What needs to change in order for your career to be AMAZING?On a scale of 1-10 how would you rate your sleep ? (10 being awesome, 1 being terrible)12345678910Rate your energy level on a scale of 1-10 (1 being a puddle of goo on the couch and 10 being happily active and able to sleep at night).12345678910Why did you choose that number?How often do you have fun? What do you do?Describe your routines around exercise and movement.How often, what time of day, what other activities you do around itDo you have a spiritual practice?How critical are you of yourself (10 being "I can't do anything right.", 1 being "I'm awesome and I love myself")?12345678910Which of the following do you often feel?* Stressed out Overwhelmed Scattered Worried Anxious Resentful or critical Jealous Angry Lethargic Depressed Stubborn StuckTherapeutic modalitiesWhat kind of therapies are you interested in? Herbs Aromatherapy Floral essences Crystal therapy Mantra therapy Color therapy It all sounds intriguing Not sureAnything else?Is there anything else that you feel is relevant to understand your current mind, body and soul?NameThis field is for validation purposes and should be left unchanged.
