Guided Reflection
I'm interested in working with a coach at this time because: {"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
If coaching worked perfectly for me, I would: {"type":"textarea","name":"__generic3","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Here's the focus area that resonates with me the most: (select all that apply)
{"type":"checkbox","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Health and Wellness: I’d like support with establishing health and wellness behaviors that feel right for me, not rigid. \nCareer: I’d like support with shaping my career or course of study so it feels connected to who I am and my unique gifts. \nParenting: I’d like support with being the parent I’d like to be and creating space for my child to develop their full and unknown potential."}
The remaining questions correspond with three focus areas above. Please complete the section(s) that resonate the most for you.
Section 1: Health and Wellness
Here's what "health and wellness" means to me:
{"type":"textarea","name":"__generic5","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
A time when I felt at peak health was:
{"type":"textarea","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My level of physical health is:
{"type":"radio","name":"__generic7","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Running on fumes\n2 - Feeling worn down\n3 - Getting by\n4 - Feeling good\n5 - Feeling strong and energized"}
I chose this rating because:
{"type":"textarea","name":"__generic8","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My level of mental health is:
{"type":"radio","name":"__generic9","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Overwhelmed and noisy\n2 - Scattered and stretched thin\n3 - Keeping up, but tired\n4 - Clear and focused\n5 - Calm, sharp, and kind to myself"}
I chose this rating because:
{"type":"textarea","name":"__generic10","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My level of emotional health is:
{"type":"radio","name":"__generic11","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Numb or on edge\n2 - Bottled up or reactive\n3 - Steady on the surface\n4 - Open and grounded\n5 - Resilient and at ease with my feelings"}
I chose this rating because:
{"type":"textarea","name":"__generic12","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My level of spiritual health is:
{"type":"radio","name":"__generic13","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Disconnected and going through the motions\n2 - Feeling like something is off\n3 - Searching for more meaning\n4 - Connected to what matters to me\n5 - Grounded in my inner knowing and purpose"}
I chose this rating because:
{"type":"textarea","name":"__generic14","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Please complete the following sentence with something specific and exciting that you'd like to be able to do (e.g., fit into my red dress and dance the night away; section-hike the Appalachian trail):
When I am in better health, I will:
{"type":"textarea","name":"__generic15","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Section 2: Career
My earliest memory is:
{"type":"textarea","name":"__generic16","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My favorite things to do as a child were:
{"type":"textarea","name":"__generic17","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
My favorite things to do now are:
{"type":"textarea","name":"__generic18","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Here's how I rate the importance of money when it comes to my work or studies in the next year:
{"type":"radio","name":"__generic19","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Not on my radar\n2 - Nice to have, if it happens\n3 - Important, alongside other things\n4 - A major priority for me\n5 - Non-negotiable this year"}
Here's how I rate the importance of impact when it comes to my work or studies in the next year:
{"type":"radio","name":"__generic20","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Not on my radar\n2 - Nice to have, if it happens\n3 - Important, alongside other things\n4 - A major priority for me\n5 - Non-negotiable this year"}
Here's how I rate the importance of expression when it comes to my work or studies in the next year:
{"type":"radio","name":"__generic21","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Not on my radar\n2 - Nice to have, if it happens\n3 - Important, alongside other things\n4 - A major priority for me\n5 - Non-negotiable this year"}
Here's what I like the most about my current role or course of study:
{"type":"textarea","name":"__generic22","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Here's what's most frustrating about my current role or course of study:
{"type":"textarea","name":"__generic23","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Section 3: Parenting
These are the top 3 most important characteristics I'd like to help my child develop:
Choose from the options below or write your own.
{"type":"checkbox","name":"__generic24","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Self-trust (listening to their inner knowing)\nCuriosity\nKindness\nIndependence\nEmotional awareness\nResilience\nCourage\nCreativity\nSense of humor\nHard work\nHealthy boundaries\nEmpathy\nResponsibility\nAuthenticity (showing up as themselves)\nCommunity-mindedness\nSelf-compassion (being kind to themselves)"}
Other:
{"type":"textarea","name":"__generic25","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
One of my proudest parenting moments was:
{"type":"textarea","name":"__generic26","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
One of my most challenging parenting moments was:
{"type":"textarea","name":"__generic27","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
I would be a better parent if I had:
{"type":"textarea","name":"__generic28","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
5. Here's how I rate my typical level of enjoyment when it comes to being a parent:
{"type":"radio","name":"__generic29","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"1 - Mostly surviving the day\n2 - Going through the motions\n3 - A mix of hard work and good moments\n4 - Enjoying it most of the time\n5 - Loving this season of parenting"}
I chose this rating because:
{"type":"textarea","name":"__generic30","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
