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Mindfulness for Stress and Anxiety
Work with Troy
Coaching Agreement Form
Coaching Preparation Form
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Date / Time
Address Line 1
Address Line 2
District of Columbia
Best Time to Call
Is it all right to leave a message on phone number and email? If no, please specify.
Date of Birth
How long at this employment
Are you happy at your current employment? If no, please tell me briefly what you would like to be doing differently.
Preferred coaching schedule: (Day and time)
Names and relationships of important people in your life: (spouse/partner, children, friends)
Do you have any difficulty with sleep? If yes, please explain.
Do you have any history or current use of drugs and/or alcohol? If yes, describe:
Are you seeing a therapist at this time? If yes, briefly describe reason for seeing a therapist.
Do you take any medications? If yes, what?
Do you exercise regularly? If yes, what type of exercise and how frequently?
How many hours of television do you watch daily?
What do you enjoy doing in your free time?
Do you have a passion in your life? If yes, what is it?
Do you have a Spiritual belief or practice? If so, please briefly describe.
What are your ambitions or goals??
What are your main issue or concerns you are looking to address with life coaching?
How did you hear about my coaching services?
What influenced your decision to work with a life coach?
Have you ever been coached before? If yes, please describe the experience: