Please list your first and last name.

What is your age?

Please list your email address and phone number.

What is your state of residence? If you are not in the United States, in which country are you living?

Are you single, married, or divorced?

If you have kids, what are their ages?

What is your occupation? If you are currently able to work, how many hours a week are you working?

For your first six sessions with me, do you prefer to meet weekly or every other week?

Please list all of your current health challenges, including mental health challenges.

Please list any past, resolved health challenges.

What practitioners have you seen on your health journey?

What practitioners seemed to help you the most, and why do you think they were the most helpful?

Have you experienced any healing in the last six months? If so, please describe your progress.

If you've seen healing in the last six months, what treatments, methods, and modalities have appeared to contribute to your healing?

Tell me a bit about your emotional health right now. What are the areas of emotional need that you feel most keenly?

Tell me a bit about your spiritual health and needs right now. If you would like spiritual support from me, in what areas would you like support?

What does a typical day look like for you?

What do you feel good about in your life right now?

How do you tend to cope when you feel discouraged and hopeless?

What activities, people, and places make you feel fully alive, joyful, and present?

Tell me about your healing dreams. What do you hope healing looks like for you?

What do you hope for in a coaching relationship?

What would you like to explore in our sessions together, if we are able to move forward in a coaching relationship? Please be specific!

Is there anything else you would like me to know?