Life Coaching Welcome & Registration Form
Please allow 30-60 minutes to thoughtfully complete this form. If you have already completed the form, or want to quickly register and fill the form out another time, please feel free to complete only the required fields. All fields will need to be filled out before your first session. Thank you for taking time to invest in YOU!
Your Name
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First Name
Last Name
Your Email
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Your Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Phone Number to Reach You
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Area Code
Phone Number
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
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Area Code
Phone Number
Relationship with Emergency Contact
What would you say is the top reason you are choosing a coach at this time? What transformation do you want to see in your business or career or personal life?
What is the second reason?
What would you say are the top three to five emotions you feel most regularly, or that trouble you the most, or cause you to reconsider your decisions and actions? Beside each emotion please make a note with a sentence or two explaining how that “shows up” for you. (For example: Jealousy - It gives me a knot in my stomach when I see my sister-in-law in her new car when she drops off the kids.)
If you could dream of the perfect job or volunteer role or position you could have and money was not an issue, what would that be and how would you feel doing it?
What are 3-4 things you would like people to say about you when your life is complete? What would it mean if those things were not said about you?
If you could erase your current biggest stress from your life, what would it be, how would it make you feel to have it gone, and what would change in your life? (Money and time are no object when we’re dreaming!)
What are 3-5 positive words to describe how you feel about yourself? What are 3-5 positive words others use to describe you?
What should I know about your personal, business, family, health history that could impact our time together or the way I approach our sessions?
What is something you secretly hope your coach can assist you with? What would you like to see happen during your time with a coach?
Is this the right time for you engage in coaching to experience the results you're aiming for?
I have all the time in the world and I'm ready. Bring it on!
I am ready but I do have other priorities that will come first. I'd rather get started than delay. I need change.
Well, I really want change but I don't have a ton of time. I kind of want to get my feet wet. Maybe once I see some change I'd be willing to make a bigger commitment.
I'm not sure. I'm nervous. I'm busy. But I do want things to change.
Other
I am ...
looking for coaching for one very specific situation only.
doing this to keep my job. My employer is sending me.
eager for life change in my career.
ready to engage in deep spirituality.
really wanting healthier relationships.
desperate to get my finances under control.
passionate about my whole life changing.
looking for someone to motivate my staff or team.
hoping to change the culture at my workplace.
Other
I have a supportive community who will encourage me as I engage on this journey.
Absolutely!
For the most part.
I have a couple of people.
Not really. One at best.
Not at all.
Choose the best option from the dropdown menu.
What kind of device will you be using for the coaching sessions? (You must have access to the internet, a video camera and microphone as all coaching is done electronically.)
Laptop
Desktop computer
Apple
Android
Phone (no video)
Choose from the dropdown menu.
I'm nervous about coaching because ...
I'm excited about coaching because ...
How did you hear about Carla Anne or Refinery Transformation Solutions?
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