Namaste Mindset "*" indicates required fields Name* First Last Email* Phone*Age* Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Session Type* In Person Virtual Preferred Session Day* Tuesday Wednesday Thursday Preferred Session Time* Morning Afternoon Evening Goals and Expectations:Briefly describe your reasons for joining...*Current Challenges:Identify any specific challenges or obstacles...*Mental Health History:Mental health history...*Medications and Treatment:Are you currently taking any medications...*Previous Coaching or Therapy Experience:Have you had any previous experience with coaching, therapy, or counseling?*Support System:Do you have a support system in place?*Coaching Expectations:Please share your expectations of the coaching process...*Preferred Coaching Style:Which coaching style do you feel would work best for you?*Additional Information:Is there any additional information...*EmailThis field is for validation purposes and should be left unchanged.
