Full Name *

Email *

Phone *

1. Before you started, what were you hoping this program would help you with? *

2. How well do you feel this program is meeting that expectation so far? *

Exceeding expectations

Meeting expectations

Somewhat meeting expectations

Not meeting expectations

3. Tell me more about your answer above what specifically is working or not working? *

4. What changes have you noticed in yourself since starting? *

5. Do you feel like you are making progress toward what you want? *

Strong progress

Some progress

A little progress

Not really

6. What feels like the biggest gap between where you are now and where you want to be? *

7. How often are you completing the pre-work? *

Every time

Most of the time

Occasionally

Rarely / never

8. What makes the pre-work easy or effective for you? *

9. What gets in the way of completing the pre-work? *

10. If you could choose, how would you prefer to receive pre-work going forward? *

Video

Audio

Written

A mix of formats

Prefer not to have pre-work and to just show up to class instead

11. How often are you completing the post-work after sessions? *

Every time

Most of the time

Occasionally

Rarely / never

12. What helps you actually follow through on post-work? *

13. What gets in the way of completing it? *

14. How clear do you feel on what to do between sessions? *

Very clear

Somewhat clear

Often unsure

15. What would make it easier for you to implement what we cover? *

16. How supported do you feel by me as your coach? *

Extremely supported

Supported

Somewhat supported

Not supported

17. When you’re struggling, do you feel comfortable reaching out? Why or why not? *

18. Where would you love more support right now? *

19. What has been the most valuable part of the program so far? *

20. What feels less helpful, unnecessary, or could be improved? *

21. On a scale of 1–10, how would you rate your experience so far? *

22. What would need to happen for this to be a 10/10 experience for you? *

23. Is there anything else you want me to know that would help me better support you? *

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