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In which state are you living?
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Your Name:
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1. What are the main areas you would like to receive coaching around? If you already have clear goals, please indicate them here.
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2. What do you feel is holding you back the most at this time?
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3. What results, specifically, would indicate that coaching has been successful for you?
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4. What would make this experience extraordinary for you?
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5. Is there anything else you would like me to know before we begin our Nurse Coaching sessions together?
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Thank you for taking the complete this brief survey! I can't wait to get started working together.
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