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Pre-Consultation Form
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Name
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Email
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Phone Number (Optional)
1. What challenges are you currently facing with anxiety?
2. How long have you been experiencing these challenges?
Less Than 6 Months
6 Months To 1 Year
1-3 Years
3+ Years
(E.g. the What
3. Have you tried and of the following to manage anxiety? (Select all that apply)
Counseling or Therapy
Medication
Self-help Resources (e.g. books, apps)
Lifestyle Changes (e.g. exercise, diet)
I Haven’t Tried Anything Yet
Other
If selected Other, please use the text box below to give more information.
Other
4. What situations trigger your anxiety the most? (E.g. Social events, health)
5. What would a successful outcome from coaching look like for you?
6. Is there any additional information you'd like to share before the consultation?
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