AltRecTherapy 1 to 1 Coaching

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Name
First Name
Last Name (not required)
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Email Address
example@example.com
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Occupation/Role
(student, at home, employed, etc)
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Preferred Communication Style:
(verbal, written, visual, etc)
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Phone Number
Please enter a valid phone number.
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Any diagnosis or special needs you would like to share?
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On a scale of 1 - 5 (1 being low, 5 being best), how would you rate your current confidence level in your personal life?Why did you choose this rating? Please fill in as much information as you are comfortable providing.
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On a scale of 1 - 5 (1 being low, 5 being best), how would you rate your current confidence level in your professional life?Why did you choose this rating? Please fill in as much information as you are comfortable providing.
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What areas of your life would you like to feel more confident in?Such as public speaking, social interactions, daily life skills, anger management, emotional regulation, impulsivity, phobias, please list them all with as much detail as you feel comfortable providing
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How do you approach setting and achieving goals?What have you tried in the past? What has worked or not worked well for you?
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What life skills would you like to improve or develop?Such as, time management, problem solving, decision making, task endurance, etc
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How comfortable are you with expressing your thoughts and feelings to others?
Very comfortable
Somewhat comfortable
Not sure
Not comfortable
Other
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What makes communication difficult or easy for you?
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Who do you currently have in your support system? (family, friends, caregivers, mentors, etc.)How often do you rely on their support?
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What is your current living situation? (living alone, with family, roommates, assisted living)How does your living environment affect your personal development?
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Are there any additional resources or support systems you feel you need but do not have access to?
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Do you engage in any recreational activities? If no, is this something you would like to explore?
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Have you ever used any Recreational Therapy techniques (art, music, games, etc.) to support your well-being?If yes, what has worked well for you in the past?
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What personal goals would you like to achieve in the next 6 - 12 months?
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Is there anything else you would like to share that will help our team better support you in your personal and professional development journey?
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