Coach Screening Intake Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Please respond as honestly as you can.What do you feel is missing in your life? *Satisfying CareerMoneyConfidence / Esteem / Self-ImageSocial ConnectionsOtherWhat do you think is keeping you from fixing this problem? *Lack of SkillsLack of InformationConfidence / Esteem / Self-ImageSocial ConnectionsLack of SupportProcrastination We life. with What steps have you tried for dealing with these challenges? *BooksCoursesVideosTherapyCoachingOtherHow do you normally make decisions? *Research and analyzeAsk other peopleGo with my instinctsHow do you end relationships ( work, friendships, romantic, etc)? *Discuss my concerns and try to resolve issuesLeave after notifying the other partyDisappear without giving noticeI am disciplined in paying my routine household bills. *YesNo Are you willing to try new responses or approaches in order to overcome your challenges? *YesNoAre you willing to talk about your fears and insecurities? *YesNoAre you willing to do assignments outside of our sessions, such as watching videos or doing written exercises? *YesNoAre you comfortable listening to feedback that might help you to make the changes you want? *YesNoDo you have issues with severe depression, suicide thoughts, or other mental health issues? *YesNoThe fee for each session is between $100 to $180, depending on which coaching package you choose. Are you able to invest this amount on coaching sessions? *YesNoWhat qualities are you looking for in a coach?Remember: Coaching is not magic. It will not transform your personality or create new talents. Coaching is about using your existing talents, strengths, and experiences to make the changes you want in life.We recommend doing at least three sessions in order to complete the entire process 1 understanding your problem, 2 changing old thoughts, feelings, and behaviors, and 3 planning how to reach your goal. You are free to do the number of sessions you desire, but the impact might not be the same.Submit