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Next Step: Explore Bravely Member/Client Intake Form

Welcome to The Brave Work

This is not a surface-level questionnaire. This is your first step into doing the brave work. Take your time. Be honest. Say the thing you normally avoid saying.

Click the button below to start.

Start

Question 1 of 23

1. Basic Information

 

Full Name:

Email:

Phone Number:

Age:

Occupation:

Relationship Status:

Question 2 of 23

2. Why You're Here

 

What led you to explore coaching right now?

(What's happening in your life that made this feel necessary?)

Question 3 of 23

If nothing changes, what are you most afraid your life will look like in 1-3 years?

Question 4 of 23

3. Current Reality

 

Where do you currently feel stuck?

(Select all that apply)
A

Career/Purpose

B

Relationships

C

Confidence/Identity

D

Emotional regulation

E

Communication

F

Worry/Fear

G

Motivation/Follow-through

H

Other

Question 5 of 23

Please explain the items you checked:

(career/purpose, relationships, confidence/identity, emotional regulation, communication, worry/fear, motivation/follow-through, other)

 

Describe what "stuck" looks and feels like in your day-to-day life:

Question 6 of 23

4. The Avoidance Patterns

 

What are you avoiding right now? (Be specific- conversations, decisions, risks, emotions, etc.)

Question 7 of 23

What do you believe that avoidance is protecting you from?

Question 8 of 23

What is it costing you to stay where you are in your life?

Question 9 of 23

5. Past Efforts

 

What have you tried before to create change?

(Select all that apply)
A

Therapy

B

Coaching

C

Programs/Courses

D

Self-help (books, podcasts, etc.)

E

Nothing consistent

F

Other

Question 10 of 23

What worked? What didn't?

Question 11 of 23

6. Fears & Resistance

 

What feels hardest or most uncomfortable about doing this work?

Question 12 of 23

What are you afraid might happen if you actually change?

Question 13 of 23

7. Readiness & Commitment

 

On a scale of 1-10, how ready are you to do uncomfortable work to create change? (Explain your number)

Question 14 of 23

What might get in the way of you fully committing to this process?

Question 15 of 23

8. Strengths & Resources

 

What strengths do you bring into this process? (e.g., discipline, insight, resilience, honesty, perseverance, heart, integrity, etc.)

Question 16 of 23

Who or what currently supports you in your life?

Question 17 of 23

9. Vision & Outcomes

 

If/when this coaching is successful, what will be different about your life?

Question 18 of 23

What does "living bravely" mean to you personally?

Question 19 of 23

Describe the version of you that you are working toward becoming.

Question 20 of 23

10. Accountability & Ownership

 

What do you need from me as your coach to challenge and support you effectively?

Question 21 of 23

How do you typically respond when someone challenges you directly?

Question 22 of 23

11. Logistics

 

How did you hear about Explore Bravely?

Question 23 of 23

Is there anything else you want me to know before we begin?

Confirm and Submit