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Thanks for your interest in coaching!

The form below is to be filled out after your free 30 minute consultation with me regarding Life Coaching. Please visit my Contact Page to schedule this meeting if you have not already done so. At that meeting, I will be providing you with an email address where you can copy, paste and answer the questions below.

Before we begin working together, please provide the following information by answering a few questions. This will ensure that at our first appointment we’ll have plenty of information to dive right in.

Enjoy this process. Perhaps make yourself a cup of tea or light a candle and allow yourself to think about the life you want to create. In most cases, this will require an acknowledgment of a life you may be leaving behind. However this comes out for you, let this be a time of quiet self-exploration and unhurried fun… You are allowed to be both a masterpiece and a work in progress simultaneously. ~Sophia Bush

*** About grief… If you have recently experienced loss and/or grief, some of these questions may not pertain to you at this time. Feel free to answer only the questions that feel pertinent to your situation.


Cell phone:

Do you mind receiving text message appointment reminders?

Would you prefer to meet by Zoom or by phone?

Email address:

What time zone do you live in?

Current address:


Emergency contact:


Why are you looking for a coach?


What would be the best outcome you could imagine as a result of coaching?


How would you like to feel at the end of your coaching sessions?


Have you ever worked with a coach or a therapist before? If so, when and for how long?


If you have recently experienced grief and/or loss, how much time has elapsed since that event?


Briefly describe your life and point out any key times when you’ve had loss, grief, sudden change or disappointment. If possible tell me what age you were at these times.





What coping skills did you use during these past crises?


What is the most effective way for me to work with you? For example, do you prefer a gentle approach, or a more assertive approach?


When taking action, which phrase describes you?

  1. I like to get a few tips from an expert and jump right in__
  2. I like to spend hours reading and asking questions before beginning to use tools__
  3. I am more interested in working with images/models than words__
  4. I like to schedule lessons with an expert or buy a book with an orderly curriculum, learning how to do things in order of difficulty__


Are you interested in/open to dream analysis?


If I had a magic wand and could grant you three wishes during our time together, what would those wishes be?





What challenges or blocks are you facing in regard to these things?



Answer these questions with the first thing that pops into your mind:

1. If I didn’t care what people thought, I would____________.

2. If I were sure I’d succeed, I would_____________.

3. If I had the nerve, I would______________.

4. If I could be certain it was the right choice, I would_______________.

5. If I weren’t worried about the future, I would_________________.

6. If I had the freedom, I would________________.

7. If I had enough time, I would________________.


Is there anything in your life you would like less of?


What else would you like me to know about you?


Thank you so much for taking the time to fill out this form. Now sit back and relax…and let’s get started.