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Name (First and Last) *

What is the best way to contact you? (Phone, email) *

How did you hear about me? *

Tell me a little about yourself. What are some of your goals and intentions for our work together? *

What are your biggest challenges or blocks thus far to reaching these goals? *

How comitted are you to the process of change and meeting these goals? *

What have you tried in the past to work through your current issues? What has been helpful? Was anything unhelpful? *

Do you have any questions or concerns for me regarding the coaching process, my style of coaching or any other related question? *