Your Story

every journey starts with a single step

It takes courage to change.
Real change starts with the small micro movements of our life. One small change creates the larger LIFE change we strive for..... you, being here today, that is significant and I am honored to be a part of your journey.

Please fill out the 'my story' questionnaire below.
*It is confidential, I am the only one on my staff with access to it.*

Be honest, put yourself all into this process. Leave the fear, shame and guilt at the door and share your heart and your soul.

There are no mistakes in life, only teachable moments, this journey is one of reflection, self love and is the foundation for all healing. Self Love is at the base of everything we'll do together.

My Story

First name

Last name

Phone

Email

Date of Birth

Time of Birth

Town, State of birth

What are your primary goals for this Coaching Program?

What Challenges or obstacles are you currently facing in your life?

How do you currently manage stress & anxiety ?

What areas of your life do you feel the most passionate about ?

What Activities & Hobbies describe your current activity level? do you feel drawn to anything physical right now that you are not doing?

What activities and or hobbies bring you the most joy?

How would you describe your current energy levels?

Have you ever (or do you suspect) been diagnosed with neurodivergence, ADD or ADHD? Have you received other diagnosis that you feel is important to your story?

Have you noticed any recurring patterns or blocks in your life? are there circumstances that keep repeating?

What does your ideal life look like?

What would you describe as your biggest blocks to living the life you want for yourself?

How would you describe the people in your life? do you feel supported by them?

What values in your life are the most important to you ?

what short term and long term goals do you have ? ( have fun here, don't get caught up in how you would manifest them )

How do you currently handle setbacks and or challenges in your life ? What is your outlet for letting off steam and managing anxiety and stress ?

What coping mechanisms have you found effective in the past? are you still using them? how have you found them effective? aka what benefits have you gained from them ?

How would you like to see yourself grow through this coaching program ?

Do you have reservations about your ability to heal and transform on this journey? if it feels active right now, what is your fear feedback loop saying to you right now ?

Is there anything else you'd like to share about your journey, yourself, your heat, your past that you feel is important to your journey moving forward ?