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1:1 Private Coaching-->Break the Pattern - Build your Legacy Coaching by Tamanna Khan

What is your name?

What is your E-mail Address?

Section 1: Context and Intention

1. What made you consider private 1:1 support at this point in your life?
Be specific. Avoid general f

2. What feels most repetitive or unresolved for you right now?
A reaction, relationship pattern, emotional state, or internal conflict.

Pattern Awareness

3. When this issue appears, how does it usually show up in your body, thoughts, or behavior? Examples: withdrawal, over-functioning, anxiety, anger, numbness.

4. Do you recognize this pattern from earlier stages of your life or family environment?
If yes, describe briefly. If no, say so honestly.

Section 3: Past Attempts

5. What have you already tried to resolve or manage this pattern?
Include self-work, therapy, courses, religious practices, or avoidance.

6. What has not worked, even though you hoped it would?

Section 4: Readiness and Capacity

7. On a scale of 1–10, how ready are you to stay present with uncomfortable emotions instead of fixing, explaining, or escaping them?
Explain your number.

8. What support do you believe you need right now that you have not been able to give yourself?

Section 5: Safety and Fit

9. What would make this work feel unsafe, overwhelming, or unhelpful for you at this stage?

10. a) Why do you feel 1:1 work is necessary for you, rather than group or self-paced learning? b) If nothing changes in the next year, what concerns you most about staying in this pattern?

This work is not about quick relief. It is about pattern interruption and emotional responsibility. Submission of this form does not guarantee acceptance into private work.