Spiritual Coaching Intake Form

​Thanks for your interest in Mindful Mile Spiritual Coaching with Jess!

Sessions are 1 hour @ $75.
All sessions will start/end at Rittenhouse Park or on the Schuylkill Trail.

During this energy-alignment session with Jess, you'll be able to share openly to get life advice and suggestions that will help you confront your concerns or get you feeling good. Your one-hour walk + talk session will be followed up with personalized insights, sharings, and suggestions complete with action-items like journal prompts or spiritual practices, which can be used as continued guidance and encouragement after your time with Jess.

To get started, please complete this form:
Email *
Name (first, last) *
Date of Birth *
Phone Number *
E-Mail *
Address *
Occupation (Company, Job Title) *
Have you ever worked with a life coach before? *
If yes, what things did you like? What things didn't you like? If no, why are you seeking out a life coach now? *
What are you hoping to achieve by working with Jess? *
How would you describe your current relationship with personal development? self-worth? *
Please describe a moment or memory in the past year you felt most happy. What about most proud? *
What area (or areas) of life is your top priority to focus on? Please list them below. *
What lights you up? What makes you excited? *
What is the happiest part of your daily routine? *
What are 3 things you feel grateful for? *
How do you motivate yourself? How do you celebrate your successes? *
How do you support yourself when you're feeling upset or stressed? *
Lastly, is there any thing else you want Jess to know before your time together?
A copy of your responses will be emailed to the address you provided.
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