NEW CLIENT QUESTIONNAIRE

A warm welcome to you! You've just taken a courageous step by committing to this mind-body work. As your coach, I will be your biggest champion and wellness mentor, but I will also challenge you if you need it. Ultimately I do believe that you know yourself best, so if something isn't working for you, I always recommend that you are open and honest with me. Coaching is about finding the solutions that work for you. I am honored to join you on this leg of your journey.

xo,
Carrie

Each person has his/her unique ways of perceiving the world and interacting with others. The following questions are to help me get to know you better. They are designed to stimulate your thinking such that our time together will be as productive as possible. I suggest you ponder the questions for a few days as you compose your responses and keep in mind that there are no right or wrong answers, just whatever is true for you.

Please take all the space you need to respond thoughtfully and submit this form to me at least 24 hours before our first session.

*I recommend that you compose your answers in a separate online document or handwrite them and then input into this form. The website does not auto-save, and you could lose your work if you attempt to fill it out over time.

Name

First Name

Last Name

WELLNESS & LIFESTYLE GOALS

What are the biggest wellness goals you want to achieve in the next 3-6 months? What lifestyle changes would you like to implement to help you achieve these goals?

WHAT ARE YOU TOLERATING?

We humans have learned to tolerate a variety of situations, behaviors in relationships (in ourselves and others), frustrations, unmet needs, lowered standards, and so on. Things that you put up with drain energy and divert focus from purpose. This could be in your physical environment (your brother losing his temper), your school environment (lack of free time), or your relationships with family and friends (not being understood). What are you tolerating? Please take some time to write down the things that you are putting up with. Simply becoming aware of what you are tolerating will bring these parts of your life into the forefront and you will naturally begin resolving them. Discuss these with me. Let’s make sure that part of our overall plan includes how to eliminate or learn to manage these energy drains.

DREAM BIG

If there were no obstacles in the way, what dream would you like to make happen?

INSPIRATION

Think about one or two people you know (or know of) who inspire you. What about them is inspiring?

HOBBIES

When you were a child, were there any activities that were so interesting to you that they could cause you to lose track of time (you had to be reminded to come home for dinner, go to bed etc.)? Please tell me about them. How about now? Are there any activities that bring peace and harmony to your body and mind today?

MOTIVATORS

How have you been motivated in the past to reach difficult goals, make difficult decisions, or do challenging things? How can we best utilize that motivator now?

RULES

If you could break any rule without consequences, what rule would you break?

BODY TALK

What is your body saying no to? What does your body need in order to heal or thrive?

INTUITIVE BELIEFS

Why do you believe you're unwell or stuck right now?

SELF-CARE

What is your definition of or conditioning around the term "self-care?" Be as honest as you can here. What words, thoughts, or images come to mind?

TWO STEPS

What two steps could you take immediately that would make the biggest difference in your current situation?

SOMATICS

Over the years, I have found that implementing some sort of somatic practice alongside coaching can be very beneficial in helping to regulate the central nervous system. What, if any, of the following might you be interested in exploring with me in our sessions?

Breathwork

TRE (aka therapeutic tremor)

Neuroplasticity

Cacao as "medicine"

WHAT ELSE?

What do I need to know about you that will help me most in coaching you?

NEW CLIENT QUESTIONNAIRE

Avocado to Zen