Rebuild Beautiful Coaching Application

Name*

Email*

Preferred Method of Contact*

Referred From?

1. Can you share your experience with grief or loss that leads you to seek a grief and loss guide?

2. Do you currently have a support system in place? If so, can you describe it?

3. How do you see communication playing a role in your journey towards healing from loss as a mother? What type of communication style or approach are you most comfortable with when receiving support?

4. Self-care is essential during the grieving process. How do you currently prioritize self-care, and how do you believe a grief and loss life guide can assist you in maintaining your emotional well-being while grieving as a mother?

5. How do you feel your role as a mother intersects with your experience of grief and loss? In what ways do you hope a grief and loss guide can help you navigate the unique challenges of mourning while fulfilling your maternal responsibilities?

6. What do you expect from a grief and loss guide in terms of support?

7. What specific goals do you hope to achieve through grief and loss coaching?

8. Are you currently working with a Licensed Professional Therapist or Mental Health Counselor?*

9. Would you like to Attend the FREE Monthly Healing Awareness & Inner Hope Step Connection Calls?

10. Would you like to be added to the Free Womens FB Support Group- Rebuild Beautiful Members?

11. Would you like to be informed of new podcasts, blogs, hands on service opportunities, walk/ run events, by receiving the FREE Monthly Rebuild Beautiful Foundation & Coaching newsletter?

12. Is there anything else you would like me to know about you or your grief journey to help us get to know each other better?