Page 1 of 2

The Mindful Career 1:1 Mentorship

First and Last Name

*

What is your email address

*

What is your phone number

*

What area of the building or construction industry do you work in?

*

What is your current role?

*

How would you describe your typical workday?

*

How would you describe your typical workday?

A

Constantly moving between tasks with little downtime

B

Managing multiple teams or projects simultaneously

C

Handling urgent problems as they arise

How often do you face pressure or tight deadlines at work?

*

How often do you face pressure or tight deadlines at work?

A

Every day

B

A few times a week

C

Occasionally

D

Rarely

How do you currently manage work pressure?

*

How do you currently manage work pressure?

A

Take short breaks or pauses during the day

B

Talk it through with colleagues/friends

C

Use exercise or physical activity

D

Just push through and get on with it

Have you worked with a mentor, coach, or similar before

*

Have you worked with a mentor, coach, or similar before

A

Yes, regularly

B

Yes, a few times

C

No, this would be my first time

What’s motivating you to look for support right now?

*

What’s motivating you to look for support right now?

A

Feeling overwhelmed or stuck at work

B

Want to handle pressure better

C

Looking to improve communication or focus

D

Want practical tools to use immediately

What outcome matters most to you?

*

What outcome matters most to you?

A

Handle pressure without it affecting my day

B

Communicate clearly even when things get tough

C

Stay focused when juggling multiple priorities

D

Find small ways to make better decisions

What’s your biggest challenge at work right now?

*

What’s your biggest challenge at work right now?

A

Managing stress or pressure

B

Keeping on top of communication

C

Staying focused and avoiding distractions

D

Finding time for myself in the day

What’s your approximate budget for this kind of support?

*

What’s your approximate budget for this kind of support?

A

Under 1k

B

6-10k

C

10k +

D

Unsure

How much time can you realistically dedicate to this support?

*

How much time can you realistically dedicate to this support?

A

1 session only (90 minutes)

B

Weekly or bi-weekly sessions over a few months

C

Monthly check-ins over a longer period

Which statement best reflects your attitude about commitment to change?

*

Which statement best reflects your attitude about commitment to change?

A

I’m ready to practice and make changes work in my day

B

I want support but might struggle to keep up the work

C

I’m not sure if I can commit fully yet

Please check each box to confirm you understand and agree:

*

Please check each box to confirm you understand and agree:

This support is not a substitute for mental health treatment or therapy.

Stacey works strictly within the scope of mindfulness as a practitioner and mentor.

I understand the financial commitment required for this partnership.

I know that real change requires my active practice and effort.

I understand mindfulness is an ongoing process and won’t create instant or overnight change.

Do you have any mental health conditions past or present that I should be aware of to support you safely during this mentorship?

*

Help me get to know you!

If you had an extra hour in your day, what would you use it for?

*

If you had an extra hour in your day, what would you use it for?

A

Sleep

B

Catching up on stuff

C

Doing something for myself

D

Time with family or mates

E

Absolutely nothing — just space

What would we find in your work bag, ute tray, or desk drawer right now?

*

What would we find in your work bag, ute tray, or desk drawer right now?

A

Snacks I forgot were there

B

4 different notepads

C

Tools, or random bits

D

Nothing — I travel light

What coffee do you drink?

*