Before You Begin
Thank you for your interest in connecting. This form is here to help us get a sense of whether now is the right time for a Discovery Session together.
The conversations I hold are intentional and meaningful whether you’re facing stress in your relationships, questions about purpose, challenges with your kids, business struggles, or feeling off in your body or mind. You don’t need to have it all figured out, just a willingness to be honest about where you are and what’s really going on.
This is not a space for casual browsing or “just checking things out.” It’s for people who feel ready to explore something real even if they’re not sure what that is yet.
If I sense that this isn’t the right fit, or that I don’t currently have the space to offer my full presence, I’ll let you know and suggest a better time to connect. Integrity and depth matter here.
Take a breath. Be real. That’s all that’s needed..
I look forward to connecting,
Steven Balin SOL, OFW
What inspired you to reach out at this time?
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Do you currently work with, any of the following?
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If others, please specify {"type":"text","name":"__generic3","width":80,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Have you worked with any of the following in the past? (check all that apply)
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If others, please specify
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Do you feel stuck, lost, or unclear in any area of your life right now?
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Feel free to elaborate if you feel called:
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How would you describe your relationship to challenges in your life?{"type":"checkbox","name":"__generic12","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"I often feel powerless or stuck\nI try to stay optimistic but it’s hard \nI’m learning to grow from challenges \nI see life as a teacher, even when it’s hard"}
Are you open to honest feed back as long as it is provided to you in a non- judgmental, safe and respectful manner ?
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What’s one area in your life you’d love to feel more clarity, ease, or change in right now?
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On a scale from 1–10, how present and connected do you feel to yourself most days? 1 not connected2345678910 very connected{"type":"select","name":"__generic6","width":50,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 not connected\n2\n3\n4\n5\n6\n7\n8\n9\n10 very connected"}
Are you currently ready and willing to invest your time, energy, and resources into making meaningful changes in your life?
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What areas of life are most calling for support right now? (Check all that apply)
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Other: {"type":"text","name":"__generic26","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
On a scale of 1–10, how committed are you to doing the work it takes to shift things?1 = I just want to vent / 10 = I’m ready to take full ownership)
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What would you love to walk away with after our session?
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How did you find me?
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Name of Person: {"type":"text","name":"__generic31","width":40,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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Source: {"type":"text","name":"__generic32","width":40,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Do you understand and agree that our conversation is confidential, and that anything shared by either party will remain in strict confidence? If so, please indicate your agreement by initialing here: {"type":"text","name":"__generic33","width":10,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Our session will automatically be booked for zoom however if you’d prefer to schedule this discovery session in person, please check “Yes” below. I’ll reach out to see if we can coordinate a time and location that works for both of us. {"type":"checkbox","name":"__generic20","width":15,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes"}
Coaching Disclaimer
By engaging in a coaching discovery session with me, you acknowledge and agree to the following:
- Coaching is a collaborative, client-led process designed to support personal growth, clarity, and transformation. It is not therapy, counseling, psychiatric care, or a substitute for medical or mental health treatment.
- I am not a licensed therapist, counselor, or medical professional. I do not diagnose, treat, or provide clinical interventions for mental health conditions.
- If you are currently experiencing significant psychological distress, trauma symptoms, or require clinical support, I strongly encourage you to seek help from a licensed mental health professional.
- All insights, tools, and perspectives offered in our coaching sessions are intended for reflection and exploration only. You are solely responsible for any actions, decisions, or interpretations you make as a result of our work together.
- Confidentiality is respected and upheld to the extent allowed by law, except where there is reasonable concern for harm to yourself or others, or as otherwise required by legal obligation.
- This agreement and disclaimer apply not only to the current session but also to all future paid sessions, unless a revised version is provided by the coach and signed by both parties.
By participating in this coaching session, you confirm that you understand and accept these terms. Please confirm by signing below.
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