Complimentary Consultation Questionnaire (noomii referral)

Please complete the following form to let me know what you hope to get from coaching, as well as a little about you and your story. It will help me understand your goals and expectations and give me a starting place for thinking about how I might be able to help you.

Take your time with this -- you may wish to download the pdf version and sit with it for a while. Download the Complimentary Consultation Questionnaire .

Answer all the questions in however much detail you wish.

Let's start with a little about what you're looking for, and any previous experience with coaching.

What goal or issue do you want to address for which you think coaching might help? *

Why consider coaching _now_? *

If coaching does what you hope, what will be different in your life? *

Have you ever worked with a coach or mentor before? *

Yes
No

Let's fill in the picture a little... tell me about you.

Gender

Age

Education

Tell me a little about your background/upbringing.

Tell me a little about your religious/spiritual background and current perspective.

What are your greatest gifts/talents/strengths?

What are your greatest challenges?

Sometimes within a coaching relationship issues will arise that are better addressed by a mental health professional. While I don't want to start out with you feeling like you're being labeled in any way, it can be helpful to know what your experience has been in order to be sure we're always doing what's in your best interest.

Have you ever been under the care of a mental health professional? (psychologist/psychiatrist/counsellor)

Currently
Previously, but not now
Never

Do you now, or have you ever, taken medications for mental health issues?

Currently taking
Previously, but not now
Never

Is there anything else you think I should know at this point?

Name *

First

Last

Email *

Phone