InnerAlly Coaching Intake Form
This is the first step towards determining if you are a good fit for InnerAlly Coaching.

InnerAlly Coaching is focused on helping you create a compassion, kind and supportive inner voice for yourself. This set of six private session will directly address the issues you are facing in life and helps you to become a better supporter of yourself, and better friend to others, even those of whom you have challenging relationships.

InnerAlly Coaching is an active, forward thinking process and aims to help you plan the "new you" that you want to see emerge.

THIS FORM IS PRIVATE - This data is stored on a Google server and access is limited to just Dr. Phelps.
Email address *
Name *
First and last name
Phone number *
Which of these describes you well? (Choose all that apply) *
Which of these describes you well? (Choose all that apply) *
What types of coaching do you prefer? (Choose all that apply)
Are you Religious, Spiritual, or Humanist? If so, we can leverage your beliefs to support the InnerAlly process. Briefly describe your views:
What kind of life transformation would you like to work towards over the next 6 weeks?
What about over the next 3 years?
What are the top 3 things you want out of life?
What do you secretly want to do with your life, but are afraid to tell anyone?
What are your biggest barriers to achieving your transformation?
What are you best coping mechanisms or skills that have helped you in the past?
Who are your biggest supporters?
How much of your life is under your control?
None of it
All of it
Clear selection
What else should I know about you to help us determine if InnerAlly Coaching is right for you?
A copy of your responses will be emailed to the address you provided.
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