Coaching Readiness Questionnaire

Please answer honestly. This helps determine whether coaching is the best fit for your needs.

1. What brings you to coaching?

2. Which best describes your current needs?

I want help setting goals and staying accountable

I want to improve habits, mindset, or routines

I want support with parenting or relationships (non-clinical)

I am struggling with anxiety, depression, or overwhelming emotions

I am dealing with past trauma or unresolved emotional pain

3. In the past 2 weeks, how often have you experienced:

Feeling anxious or on edge

Never

Sometimes

Often

Very Often

Feeling down, depressed, or hopeless

Never

Sometimes

Often

Very Often

Difficulty controlling emotions

Never

Sometimes

Often

Very Often

Panic attacks or intense fear

Never

Sometimes

Often

Very Often

Intrusive thoughts or memories

Never

Sometimes

Often

Very Often

4. Are you currently experiencing any of the following?

Thoughts of harming yourself

Thoughts of harming others

Feeling unsafe or in crisis

None of the above

5. Have you ever been diagnosed with a mental health condition?

Yes

Prefer not to say

If yes, please specify (optional):

6. Are you currently in therapy?

Yes

If yes:

I plan to continue therapy alongside coaching

I am looking to replace therapy with coaching

7. What are you hoping to gain from coaching?

8. Which best describes you right now?

I feel stable and ready to focus on growth

I have some challenges but can manage day-to-day life

I feel overwhelmed and need support managing my emotions

I feel stuck in patterns I cannot control

9. Are you able to take responsibility for implementing changes between sessions?

Yes

Unsure

Your Contact Information

Phone Number

10. Agreement

I understand that coaching is not therapy and does not include diagnosis or treatment of mental health conditions

I understand I may be referred to therapy if coaching is not appropriate for my needs

Signature (typed name)

Date

The Growth Edit Co.

Therapist-informed coaching for individuals ready to break cycles and build emotional clarity.

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Disclaimer Coaching Agreement

Coaching services are non-clinical and not a substitute for therapy.