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The Grounding Path - Intake

Welcome! I am so happy you've chosen to begin with The Grounding Path. This intake form helps us center your needs, clarify your goals and prepare for our time together. Please complete this before booking your first call.

Full Name

What name do you prefer (if different from above)

Date of Birth

Email Address

Phone Number (optional)

Mailing Address

Current Occupation

Describe your current life status ( single, married, children (ages), separated, divorced, common law or other)

What inspired you to say YES to The Grounding Path Sessions?

Are you currently in a life transition or facing a challenge you would like support with?

Are you currently in a life transition or facing a challenge you would like support with?
A
B

If YES to above Please describe your situation here

Have you ever worked with a life coach, therapist, or mentor before?

Have you ever worked with a life coach, therapist, or mentor before?
A
B

If YES to above, what did you find most helpful? Or not helpful.

What do you hope to gain or clarify in our two sessions together?

If you could walk away with one big insight or shift, what would it be?

Do you agree to the following:

I understand coaching is a collaborative process and not a substitute for therapy or medical care

I understand coaching is a collaborative process and not a substitute for therapy or medical care
A

This is a one time package valid for four months from the date of purchase.

This is a one time package valid for four months from the date of purchase.

This package is non-refundable.

This package is non-refundable.

The $111 fee may be applied as a credit towards a future coaching packages (if booked within 30 days of purchase).

The $111 fee may be applied as a credit towards a future coaching packages (if booked within 30 days of purchase).

I consent to email communication for scheduling and coaching support.

I consent to email communication for scheduling and coaching support.