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Kara@AuthenticExpressions.net

Intake

Welcome to AUTONOMY Momentum!

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

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 45-min 1:1 Discovery Session. I look forward to getting started with you and helping you gain momentum!

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 *

Please select ALL of the times that could work for you for weekly group coaching sessions (Choose as many as you are able - the more the better!) *

Tuesday - 2pm EST
Tuesday - 3pm EST
Tuesday - 4pm EST
Tuesday - 5pm EST
Tuesday - 6pm EST
Tuesday - 7pm EST
Wednesday - 2pm EST
Wednesday - 3pm EST
Wednesday - 4pm EST
Wednesday - 5pm EST
Wednesday - 6pm EST
Wednesday - 7pm EST
Thursday - 2pm EST
Thursday - 3pm EST
Thursday - 4pm EST
Thursday - 5pm EST
Thursday - 6pm EST
Thursday - 7pm EST

Best Way to Reach You (email, text, Forum, etc.) *

Date of Birth *

Name & Relationship of Important People in your Life (Including Mate and Children) *

What are you most excited to get from group accountability coaching? *

Describe three things you want to achieve or accomplish as a result of group coaching? *

Why do you want to achieve these things? *

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 would you say have been your three greatest accomplishments to date? *

What are you most grateful for in life? *

List 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 is your vocation (your true calling)? What are you here (in life) to do? *

Who inspires you? Why? *

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? *

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 three main focus areas for this 3-month 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? *

Authentic Expressions Coaching

Life and Accountability Coaching designed to help you get out of your own way so you can get unstuck, level up your productivity, and become who you're meant to be.

Contact

Kara@AuthenticExpressions.net
Bellingham WA