InnerAlly Coaching Intake Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Purpose
The purpose of this intake form is to help you get clear about what you want to address during our coaching sessions, including the types/styles of coaching and support you desire, and to help me better serve you on our 30-minute breakthrough call.

Scheduling the Breakthrough Call
Once you have completed the intake form and press the submit button, you will be presented with a link to my calendar to schedule your free 30-minute breakthrough call. This session is 100% for you and you can use it to see if we are a good fit to work together, and/or you can use it to address an issue that you are struggling with. It is not a sales pitch.

Trauma Informed Coaching
I want to assure you that my coaching is designed with a trauma-informed approach, prioritizing your well being throughout the process. I do not seek to diagnose or label you in any way. I aim to create an environment of understanding and self-awareness, enabling you to explore your emotions without fear of negative consequences.

Emotional Wellbeing
Being honest about your thoughts, emotions, and personal experiences can sometimes feel challenging. Please know that this process is designed to be supportive where there will be no judgment. My primary goal is to provide you with insights into your emotional needs, allowing us to tailor inner compassionate language specifically for you to help you thrive in life.

No Blame
I want to emphasize that everyone has unique experiences and challenges, and your challenges will be treated with utmost respect. Coaching is about assessing our current situation and planning a path forward to the life you want.

Privacy
Your intake form data, and the InnerAlly coaching are confidential. THIS FORM IS PRIVATE - This data is stored on a Business Google server and access is limited to Dr. Phelps.

The Questions There are no right or wrong responses, and each question is an opportunity for self-reflection and growth. Your well-being is the priority, so if you need to skip any questions, please do.

InnerAlly Coaching InnerAlly Coaching is focused on helping you create a compassionate, kind and supportive inner voice for yourself. This set of six private sessions 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 especially 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.

Individual sessions are $150/hour and 6 session packages are discounted at $750.

Email *

Name *

First and last name

Phone number *

Which of these describes you well? (Choose all that apply) *

Sometimes I feel like my own worst enemy

I have a very active inner critic

I tend to take care of others and ignore my needs

I am a perfectionist

I find it hard to describe how I feel (naming emotions)

I find it hard to forgive myself when I fail or disappoint

I have trouble setting boundaries, or I don’t set boundaries

I tend to be much harsher when I speak to myself, than when I speak to others

Required

Which of these describes you well? (Choose all that apply) *

I feel stuck in life and/or work

I feel burned out and/or overwhelmed

If anyone really got to know me, they would be disappointed

I'm not getting what I want out of life

I'm using some unhealthy coping mechanisms

I have compassion fatigue (have lost the drive to care for others)

Required

What types of coaching do you prefer? (Choose all that apply)

Exploring and removing blocks and obstacles to your success

Listening, supporting, encouraging and validating

Providing insights and reflecting

Painting a vision of what you can become

Planning the steps to change for the future

Accountability towards reaching your goals

Are you Religious, Spiritual, or Humanist? If so, we can leverage your beliefs to support the InnerAlly process. Briefly describe your views if you wish.

TRANSFORMATION

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?

MAKING IT HAPPEN

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.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of InnerAlly.

Does this form look suspicious? Report

Forms