• Guy Soucy - Well-Being Specialist

  • Client Intake Questionnaire

    1:1 Emotional Well-Being & Transformation Coaching

     This form helps me understand your inner landscape, your current challenges, and the transformation you're seeking.  Your answers will remain confidential and will guide the focus of our sessions.

    🌐 www.guysoucy.ca
    📩 guysoucy.coach@gmail.com

  • Section 1: Personal Information

  •  - -
  • How would you like to communicate (Zoom or WhatsApp)*
  • Are you willing to do what it takes, to challenge yourself, to get OUT of your comfort zone, to invest time and energy to move forward towards your goal?*

  • Section 2: Your Current Situation

  • Section 3: Emotional & Nervous System Patterns

  • How would you describe your emotional state most days? (check all that apply)*
  • When you feel stressed, anxious, or overwhelmed, how does your bod typically respond?*

  • Section 4: Your Life & Environment

  • What areas of your life feel most challenging right now? (check all that apply):*

  • Section 5: Your Goals & Desired Transformation

  • What would you love to feel more of in your life? (check all that apply):*

  • Section 6: Past Work, Tools & Growth Experience

  • Have you worked with a coach, therapist, or healer before?*
  • Are you currently working with a therapist, counselor, psychologist, or mental health professional?*
  • Have you ever been diagnosed with a mental health condition (e.g., anxiety disorder, depression, bipolar, PTSD, or other?)*
  • Are you currently taking any medication related to mental health, mood, or emotional regulation?*
  • Do you currently use any self-regulation or wellness practices? (check all that apply):*

  • Section 7: Commitment & Expectations

  • What do you need from me as your coach? (check all that apply):*

  • 🌿 Coaching Disclaimer & Agreement

    Please read the following carefully:

  • Coaching is a collaborative, supportive process focused on emotional regulation, personal growth, mindset, and nervous-system resilience.

    My role as a coach is to guide, support, and empower you using tools such as emotional regulation, nervous system techniques, somatic awareness, and mindset reframing.

    Coaching is NOT a substitute for psychotherapy, mental health treatment, or medical care.

    This means:

    • I do not diagnose or treat mental health conditions
    • I do not provide psychotherapy
    • Coaching should not be used in place of professional mental health support when needed
    • If you are experiencing severe psychological distress, crisis, or symptoms requiring medical/clinical intervention, I may recommend or require referral to a licensed mental health professional

    If you are currently working with a therapist, psychologist, psychiatrist, or any mental health professional, it is recommended that you inform them that you are also participating in coaching.

    This helps ensure that your overall support system is aligned and consistent.

    You agree to seek professional medical, psychological, or psychiatric support when necessary, and to inform me of any conditions that may impact your coaching process.

    By signing below, you confirm that you understand the nature of coaching, the difference between coaching and therapy, and that you take full responsibility for your emotional, mental, and physical wellbeing during the coaching process.

  • Date*
     - -
  • Should be Empty: