Request edit access
Intake form
Welcome! This is your first step, for 'something' to change. 
This form consists out of 6 questions, and will probably take you up to 30 minutes to complete.
I encourage you to answer them with enough detail to give me an impression of your personality, life and current situation. Your information is safe and private here. 
Sign in to Google to save your progress. Learn more
Email *
What is your first and last name? *
I'm interested in: *
Why do you wish to be coached by me?
Do you maybe have a longing/need/wish for something, that you wish to create, shape or form in these coaching sessions - together with me (and your partner)?
 *
Do you have a specific reason or motivation?
Has something happend? Or are there reoccurring themes, situations or conversations that you can’t seem to solve or change, individually or as a couple - according to you?
 *
What is (currently) going on in your life?
how is your health, living environment, family, relationships, work?
 *
What are your top 3 priorities and top 3 stressors? *
What do you live towards to?
Do you have a goal or vision for yourself (and your relationship)?
 *
What would you like to get out of these coaching sessions?  *
In what timeframe do you want to start the sessions? *
Any questions? Or remarks?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms