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My Story
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FAQ
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Home
My Story
My Practice
Book Sessions
workshops
FAQ
Get in touch
Preliminary Questionnaire
Please feel free to skip any question below.
Email for non-humans
Name
Address
Phone
Email
Birthday
Spouse name
Children names
Education
Previous occupations
Current occupation
General Health
Diagnosed with ADD/ADHD?
Yes
No
When?
If so, do you use meds?
Other family members with ADD/ADHD?
Have you worked with a counselor/therapist?
Yes
No
How do you like to learn?
Visual (See the picture or color)
Tactile (touch)
Auditory (hear)
Verbal (speak out loud and free-associate)
Kinesthetic (moving and doing)
Cerebral (think about the big picture and make sense of the puzzle)
Hobbies/Sports you enjoy or play? And why?
Things you do on a daily basis that keep you (mentally, physically, emotionally, spiritually) well?
What are you most proud of having accomplished and why?
Your greatest strength, gift or talent is…
When do you find yourself enlisting it the most?
Your greatest weakness is…
What you want more of in your life is…
Your friends would describe you as…
Your 5 greatest values are…
What motivates you is…
When you are at your best, how would you describe yourself?
What are you putting up with that is holding you back? (bad habits, beliefs, unhealthy relationships, recurring problems…)
Things your are now willing to do or change
3 Goals you want to achieve over the next year: (list the ones you really want, not the ones you should, could or ought to want!)
What are your personal and professional benefits of accomplishing these goals?
How will you make sure that you get the most out of our coaching/consulting relationship?
Anything else I need to know?
Submit
