Questionnaire

Discovery Session Questionnaire

With Dr. Alexis Shepperd, PhD
If you’re ready for deep and lasting changes in your life and relationships, you are in the right place.

Please tell me a bit about yourself and why you’re interested in working with me in the questions below.

Then I (or someone from my team) will contact you to schedule an exploratory Zoom conversation. This will be an experience of deep coaching and an opportunity to answer all of your questions.

I look forward to connecting with you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Age*
Profession or type of work you do:*
Relationship status:*
Which Programs Are You Interested In? (Check All That Apply)*

Individual CoachingCouple's CoachingMen's ProgramsAWE & Women's ProgramsCircling Training or MentorshipOther
Where do you live?*
City, State, Country
Select your time zone*
Please suggest a few days and times when you are available for a conversation.*
I work with coaching clients over video, not in person. This means you can work with me from anywhere in the world. It is surprisingly powerful and and as effective as meeting in person. Is that something you are comfortable with? (If not, then I'm not the right coach for you).*

YesNoN/A--I'm inquiring about an in-person workshop
How did you hear about me?*
1. What is drawing you to work with me? Why me, and why now?*
2. What is your heart’s desire? What is your big dream? If you could get anything you wanted from your work with me, what would it be?*
3. What are you struggling with? What areas of your life are the most challenging right now?*
4. On a scale from 1-10, how important is it to you to transform these challenges in the next 6-12 months? Please rate each one.*
5. Imagine yourself on the other side of working with me. What will your life look like once you’ve transformed your challenges and created what you most want? Be specific.*
6. Assuming that all human beings have some way of holding back or sabotaging their lives, which are your favorite methods? What would you have to let go of to get the most out of coaching with me?*
7. Level of interest and commitment: (choose one)*

I’m committed to taking my life to the next level and I’m ready to hire a coach.I’d like to make changes in my life and I’m considering working with a coach, but I’m not sure about the right next step for me.Other
8. Are you in a financial place to invest in yourself to get the support you want?*
9. What kind of coaching, therapy or personal growth work have you done in the past? How did it go?*
10. Is there anything else you’d like to share with me?
Thank you so much! I’ll be in contact with you soon.
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Discovery Session Questionnaire