Thank you for your interest in working with me!
All the information requested by this form is intended to help me know you better so I can coach you more effectively, AND it is completely optional.
Please fill out what you’re comfortable sharing and leave the rest blank. Or don’t fill it out at all, and we can cover whatever we need to in your first coaching session. You get to choose what works best for you.
Click the button below to start.
Question 1 of 16
Who do you live with? First names are great, and anything you’d like to share.
Question 2 of 16
What do you do? This can include your career and any other work you do.
Question 3 of 16
Do you have ADHD, anxiety, depression, dyslexia, autism, or any other learning or mental health diagnoses that you’re comfortable sharing?
Question 4 of 16
Do you take medication for this diagnosis? And if so, do you feel the medication is working adequately for your needs?
Question 5 of 16
Do you have any medical or general health concerns that you’d like me to be aware of?
Question 6 of 16
How do you feel about your sleep? Do you feel like you generally get enough?
Question 7 of 16
How do you feel about your diet? Are you comfortable that your nutritional needs are met?
Question 8 of 16
How do you feel about your movement and activity? Are you happy with your current activity level?
Question 9 of 16
How do you feel about relaxation and mindfulness? Are you regularly able to engage in relaxing activities?
Question 10 of 16
Do you regularly get to the doctor for healthcare and checkups?
Question 11 of 16
Do you have any health habits that you are specifically concerned about?
Question 12 of 16
Is there anything you’d like me to know about your professional life?
Question 13 of 16
Is there anything you’d like me to know about your friends and social life?
Question 14 of 16
Is there anything you’d like me to know about your family life?
Question 15 of 16
Do you have any hobbies or favorite activities? Or, what do you love to do when you have free time with no obligations?
Question 16 of 16
What else would you like me to know at this time?