Welcome to Butterfly Bliss Coaching

Welcome to Butterfly Bliss Coaching

Your journey matters here!
Life Coaching Discovery Call Assessment Form

Please complete the following assessment form to help us better understand your needs and goals.
Discovery Call—Just ExploringFlex Coaching Opportunity"The Role" Choice Program"Echo Elevation" Choice Program
Welcome! Get started...

▸ Instructions:
Answer each question from your most immediate thought or feeling as it is often the truest reflection of where you are right now—it’s pure, unfiltered, and closest to your heart. Where applicable; measure your answer on a scale of 1–10 (10 = feeling your best / strongest, 1 = lowest / needs most support).

👉 ▸ Once you complete the form, simply click Submit.
👉 ▸ Upon submission, you’ll receive the option to schedule your appointment.
👉 ▸ Once your appointment is scheduled—that’s it! 🎉

I look forward to connecting with you soon!

With grace and purpose,

Coach V.

ᴀꜱ ɪʀᴏɴ ꜱʜᴀʀᴘᴇɴꜱ ɪʀᴏɴ, ꜱᴏ ᴏɴᴇ ᴘᴇʀꜱᴏɴ ꜱʜᴀʀᴘᴇɴꜱ ᴀɴᴏᴛʜᴇʀ.

Venecia Chavez
Certified Life and Relationship Coach
Butterfly Bliss Coaching
📞 (720) 767-3462
📧 vchavez@butterflyblisscoaching.com
🌐 www.butterflyblisscoaching.com
Full Name*

PrefixFirst NameMiddle NameLast Name
City*
State
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What inspired you to reach out for support at this time? (This is a 2 part question, please number your answers.)*
1️⃣.) Share a little about what’s been on your heart or mind lately. 2️⃣.) Describe your life right now in three words, what would they be?
Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied
How aligned and joyful does your life right now?
On a scale of 1–10, how balanced do you feel across work, relationships, faith/spirituality, and personal care?
What "does 👍" feel in alignment?
Your most immediate thought or feeling is often the truest reflection of where you are right now—it’s pure, unfiltered, and closest to your heart.
What "does not 👎" feel in alignment?
Your most immediate thought or feeling is often the truest reflection of where you are right now—it’s pure, unfiltered, and closest to your heart.
Where do you feel stuck, overwhelmed, or looking for change?
Your most immediate thought or feeling is often the truest reflection of where you are right now—it’s pure, unfiltered, and closest to your heart.
On a scale of 1–10, how satisfied are you with where you are today?
Your most immediate thought or feeling is often the truest reflection of where you are right now—it’s pure, unfiltered, and closest to your heart.
What are your main goals or areas of focus that you would like to work on with a Life Coach?*
From your perspective what challenges or barriers might currently be preventing you from reaching your goals?*
If things were going really well six months from now, what would look different?*
What does breakthrough or success from this opportunity look like for you?
What’s one small step you’re ready to take right now toward your goals?
What support have you tried in the past, and how did it feel for you?
Very committedSomewhat committedNot sureNot committed
On a scale of 1-10, how motivated are you to make changes and take action towards your goals?*
With a coach by your side, what would be the most valuable way they could support you?
What is your preferred method of communication?*
Is there any additional information you would like to share with the life coach?*
Consent / Terms: “I understand this Discovery Call is for consultation purposes and does not constitute a coaching agreement.

Terms of Service & Privacy Policy
By submitting this form, you agree that the information you provide will be used solely for scheduling, communication, and service delivery related to Butterfly Bliss Coaching. Your personal information will not be sold or shared. Submission of this form does not create a coaching agreement. All services are subject to availability and discretion.
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Welcome to Butterfly Bliss Coaching

Life Coaching Discovery Call Assessment Form