Emerge Program Intake Form – Helen MacMillan

Emerge Coaching Program Questionnaire

The following questions are designed to be pondered, and to stimulate your thinking in a way that will make our work together productive and rich. Some questions will be simple facts, while others will take some time and you might have to answer from your intuition. Enjoy the process as many clients tell me that the questionnaire helped them get a lot more clarity and a few "aha's". Take all the space you wish to answer them.

First Name *

Last Name *

Contact Phone *

Email *

(Setting Your Intentions) What are you hoping to get out of this process/program? *

Why did you decide to enroll in this program? *

What would you like to achieve as a result of our work together? *

What do you most want to get out of the coaching relationship? *

What anxieties (if any) do you have about this program? *

(Your Focused Questions) What is your life purpose or mission? *

Do you have a vision or mission statement for your life?

Yes No

What do you value most in life? What is most important to you? *

What has happened in order for you to feel like you are honoring your life values? *

What are the core beliefs about life that determine how you think, act and feel each day? *

What are your current self-care practices and how often do you do them? *

What are the top 3 challenges you are facing in your personal life right now? *

What are the 3 most common emotions you feel in an average week? *

In what areas of your business and/or life are you avoiding making decisions? *

What are you tolerating right now? *

If I could grant you three wishes, and you could wish for anything, what would you ask for? *