Intake

Welcome to Nurturing Mamas!

The questionnaire below serve two purposes: to get to know you and to help you get clear about what you want from this experience.

Please answer completely to assist me in providing you with the most comprehensive coaching experience.

Take your time with these questions. Some people choose to write out their answers in a separate document, then copy and paste their answers in when ready to submit.

As soon as you submit this form, you will be redirected to schedule your 30-min 1:1 Discovery Session. I look forward to getting started with you and helping you step into the woman and mother you want to be!

Full Name *

First

Last

Name you would like to be called *

Phone Number *

What part of the world do you live in? (If in the USA, please provide city and state) *

Email *

Best Way to Reach You (email, text, phone call) *

Date of Birth *

Name and ages of your children - and name of your primary partner (if applicable) *

What are you most excited to get from this experience? *

Describe what you most want to achieve or accomplish by the end of this program? *

Where do you get slippery, make excuses, or might even try to sabotage yourself? How will I know it? *

How do you want me to handle that? *

What are you most grateful for in life? *

List 3-5 things you are tolerating or putting up with in your life at present. (examples could be clutter, rude friends, conversations that need closure, poor environment, etc.) *

What accomplishments, in your opinion, must occur during your lifetime so that you will consider your life to have been satisfying and well lived- a life of few or no regrets? *

Who inspires you? Why? *

What actions or habits, if taken on a regular basis, would make a big difference for you in your life? (i.e. meditation, working out, nature walks, reading, etc.) *

How do you generally handle crises when they arise in your life? *

What’s missing in your life? *

Identify one or two main focus areas for this stretch of our work together. For each focus area provide a simple heading, a description of a measurable outcome, and answer, in detail, the questions: 1) What will my life be like —what will I enjoy and how will I feel after I’ve achieved this goal? 2) What would my life be like —what challenges will I face if I don’t handle this goal? *

Intake

Welcome to Nurturing Mamas!

Authentic Expressions Coaching

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