Women's Group Coaching Application
Let me know how I can support your goals.
Full Name
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First Name
Last Name
Phone
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-
Area Code
Phone Number
E-mail
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Briefly describe your situation.
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I struggle most with...(select all that apply).
Self Awareness
Emotional Rollercoaster
Communication
Confidence
Setting healthy boundaries
Other
What have you tried that hasn't worked already?
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What have you LEARNED from what didn't work?
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What do you hope to accomplish from group coaching?
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How committed are you to working towards achieving your goals?
I'm Ready. Let's Go!
A little nervous, but ready.
I'm hoping to be motivated through the process.
It depends...
Will you welcome an Accountability/Support partner?
Sure!
No. I'm a DIY expert.
Possibly.
List three things you are grateful for in your life right now.
Are you willing and able to attend each (6) weekly group session?
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This is a virtual experience. (Zoom and/or Facebook Required)
What days work best for you?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What times work best for you?
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Morning
Afternoon
Evening
Are you currently under the care of a therapist, counselor, or social worker?
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Yes
No
A referral or approval may be required.
How do you prefer to be contacted?
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Call
Text
Email
I would like to be notified about promotional services. Please note that we do not rent or sell your information to any third parties!
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Yes
No
Submit
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