REFERRAL - Three Months of Private Coaching - 3 Installments - Shauna Gullbrand Coaching

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A Journey to Knowing Your Self More Deeply


Hi client,

The purpose of this worksheet is to let you take a moment to create and define what it is you would like out of our coaching work together.  First read all of the questions below, and then answer them from top to bottom giving no more than 2 minutes to each.

Have you worked with a coach before?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If Yes, what type of coaching did you receive?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What kind of changes are you looking to make within yourself and in your life?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


In what way(s) do you hope coaching will help you?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What goals would you like to accomplish over the next 6-12 months?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What challenges are you currently facing?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


Let's talk about happiness in life.  Which best describes your level of happiness.{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"1. I'm miserable and I can't find anything to be happy about.\n2. I have moments of happiness but then something comes along and ruins it.\n3. Happiness is something I crave in my life.\n4. I easily create and enjoy happiness in my life.\n5. I'm a happy person and love to bring happiness to others."}


What makes you most happy in your life currently?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


Let's talk about stress for a moment.  Which best describes your level of stress?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"1. Stress is killing me!\n2. I'm angry all the time.\n3. I often feel overwhelmed. \n4. I experience stress from time to time but it's no big deal.\n5. I know how to meet my stress in the moment and dissolve it before it takes hold."}


What causes you stress?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What changes would you like to see in your life?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What previous steps have you already taken to achieve your goals?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What has been the result so far, and what have you learned?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What does your "ideal" day look like?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


How do you want to see yourself a year from now?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


How willing are you to do the necessary "work" between our sessions?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"100% willing!\nI'm willing to do my best.\nI can do that, but I'll need reminders.\nI'm not sure if I'm willing to.\nNot willing at all."}


What kind of spiritual practices and disciplines do you engage in?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What are you self-care practices?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


List 4 values that are important for you to live by.{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


Have you engaged in any Inner Child work?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Yes\nNo\nI'm not sure"}


How willing are you to cultivate a meaningful relationship with your Inner Child?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Absolutely willing\nI'm open to the idea\nNot willing at all. I have no interest."}


How would you describe yourself?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What are you most passionate about in life?  What are your interests?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


Do you take physical action on your passions and interests?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo"}

If not, why?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What do you believe to be true about yourself?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What do you believe to be true about life and the world around you?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What do you believe to be true about your feelings and emotions?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


List your current top priorities in order of importance.
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


List three things that trigger you into a strong emotion.{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What, or who, do you point a finger of judgment at?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


When does resistance show up for you?  What, or who, do you have a tendency to resist?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What is the compliment or acknowledgment you hear most often about yourself?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}


What is your ultimate goal from our time together?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}




Thank  you for taking the time to invest in your Self and for answering these questions with honesty.  I look forward to our first coaching call.

Cheers!
Shauna

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