Pre-Coaching Questionnaire
Please allow some time to complete the entire form before our initial call. Your responses will help to provide better support and resources tailored to your needs.
Section A: Personal Information
Full Name
*
First Name
Last Name
Gender
Woman
Male
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section B: Contact Details
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Skype ID (if applicable)
Section C: Divorce Coaching
What stage are you currently in regarding your separation or divorce?
*
Contemplating separation or divorce
In the process of a separation or divorce
Recently separated or divorced
Transitioning Post-divorce
Other
What is the PROBLEM? Why do you want coaching? What is the ONE THING you most want to achieve as a result of our coaching services?
*
What are the three biggest challenges you are currently facing?
*
Financial stability, Child custody
Child Custody
High conflict Co-Parenting relationship
Housing
Divorce Legal Proceedings
Personal safety
Career/job stability
Health and well-being
Domestic Violence
Other
How long have you been married?
Who made the decision to separate or divorce and why?
*
Do you have children?
Please Select
yes
no
How many children do you have?
What are their ages?
What are your custody arrangements, goals, and concerns?
Do you have a Co-Parenting Plan?
Yes
No
Have you retained a lawyer? Tell us about the legal process thus far.
Currently seeing a therapist? If so, what are you getting out of it?
What are your main goals for the next six months?** (Check all that apply)
Emotional healing
Financial planning
Establishing a new home
Career advancement
Building a new social network
Improving physical health
Enhance parental skills
Other
How will your life be different as a result of achieving this Goal?
What do you think will prevent you or get in the way of you achieving your goals?
What personal goals do you have post-separation or divorce?
What would you like me to do if you fall behind on your goals?
What major transitions have you had in the past two years?
In order to succeed, what part of you do you want to call forth and see more of?
Over the next 3-5 years, what are the three most important changes you must see in your life personally and/or professionally?
How will you know when you are receiving value from our coaching partnership?
What type of additional support or resources do you feel would be most beneficial to you at this time? (Check all that apply)
30 min Free Consultation
1:! Coaching Sessions
Group Coaching
Workshops
Women's Empowerment Ministry Group
Low Cost Personal & Family Legal Services
A Customizable Co-parenting Plan
Business Legal Advice
Estate Planning (Will)
Financial Planning/ Budgeting Services
Child Care
Other
Please provide any additional comments or information you feel would be helpful. Thank you for taking the time to complete this questionnaire.
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