Full Name:

Street Address:
include city, state and zipcode

Phone Numbers- PLEASE INCLUDE AREA CODES
Home:

Work:

Cell:

Fax:

E-mail:

Date of Birth:

Emergency Contact Name:

Emergency Contact Phone Numbers- PLEASE INCLUDE AREA CODES
Home:

Work:

Cell:

PERSONAL

1. What gives you the greatest joy?


2. What do you regret not having done in your life?


3. What are you passionate about?


4. What are your five greatest strengths? Five greatest obstacles?


5. What is your favorite color, food, place in nature?


6. What’s missing in your life?


7. What are the things that you judge in other people? What makes you angry, irritates, or disappoints you in other people and why?


8. What are your core values in life?


9. If you are aware of your life’s purpose, what is it? Are you sure? What effect does it have on your life?

HEALTH

10. Regarding your health, what would you like me to know and are there some areas in which you would like support?



11. On a scale of one to ten—one being unhealthy and ten being incredibly vibrant—where are you now?


PROFESSION


12. What is your profession? What attracted you to this profession?



13. What do you love about your work? What do you like the least?



14. Is this the work that you would like to do for the rest of your life? Why or why not?



15. If you could have the perfect career, what would it be and how would your life be different?

OTHER

16. Is there anything you would like to share about your relationships, family, or your living situation?


17. What would you like me to know about you? What are you afraid for me to know about you?



18. What is your greatest potential?



19. It can be a valuable tool in our relationship for me to know a bit about the key events of your life. If you have the time, it would be valuable to create a brief timeline of your life from birth (or before) to present time.



20. Are you currently under the care of a mental health professional?
Yes
No
If so, have they prescribed any medication? Please list all medications here

Are they aware that you are embarking on Soul Coaching?
Yes
No

Do I have permission to call your doctor or therapist?
Yes
No
If so, what is his or her name and number?



I understand that Soul Coaching is not therapy and is not intended to provide therapeutic intervention. It is a spiritual system that allows me to create my future in accordance to my innermost yearnings.

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Thank you for taking the time to fill out the PROFILE FORM!