BE THE WORK Private & Couple's Coaching with Dr. Stefanie

Dr. Stefanie maintains a reserved client roster so she can bring tremendous focused attention to each client. To begin the conversation, please complete the form below.

Date

Name

Phone

Email

Is there anything health-related we should be aware of that might affect our work together? (Optional)

Are there any mental health diagnoses or conditions we should be aware of?

Is there anything from your mental/emotional history that feels relevant to share as we consider working together? (Optional)

Are you currently taking any medications we should know about?

Have you worked with a therapist, psychologist, or coach before? Please explain a bit about the practitioner and how that experience was for you? What worked well? What could have been better?

Are you currently working with a therapist, psychologist, or coach?

If you are currently working with a therapist, psychologist, or another coach, it's helpful to know. Dr. Stefanie's work is most effective when there is clarity about your various supports. Please indicate your current arrangement below.

If you are currently working with a therapist, psychologist, or another coach, you may be asked to pause that work while coaching with Dr. Stefanie. Her approach is most effective as the primary modality. Attempting to blend it with another active therapeutic relationship tends to dilute the effectiveness of both. Please indicate 'Yes' or 'No' that you understand and agree.

What does your current wellness practice look like? (Examples: meditation, movement, therapy, journaling, etc.)

What brings you to this specific moment of wanting coaching? What has to change, and what have you already tried to get there?

What are you interested in focusing on in your coaching sessions?

When are you hoping to begin?

Are you currently a business owner or self-employed? (This helps us mention relevant tax considerations if applicable.)

Which container feels right for where you are?

My coaching calendar is limited. Current availability is Tuesday, Wednesday, and Friday afternoons. Please indicate all that work for you:

How did you hear about Dr. Stefanie?

Anything else you would like us to know for now...