Coaching with Courtney Interest Form

Designed to understand you better.

I support you by meeting you exactly where you are in life. Whether it's figuring out your next step, helping you to get unstuck, managing grief & loss or your relationship with alcohol and other healthy habits. When I'm in your corner, you receive personalized support, accountability and positive change.

Please tell me about you

This form is designed to help me understand you a little better.

Rest assured, all information shared will be kept private and confidential.

Once you submit the form, you’ll receive an email from me within 24 hours or the next business day with details on the next steps. Most likely, we'll be booking a Zoom call to chat further.

Feel free to share as much or as little as you like though your email address is required so I know how to reach you to set up our

intro zoom call.

First name

Last name

Phone number

😞 Where are you feeling stuck or challenged?

💬 Please tell me a little about yourself.

😇 Have you worked with a coach before to achieve these goals or different goals?

🎯 What helps you to be focused, present, or grounded?

🌈 What are 3-5 things you LOVE about your life?

🩺 Do you have any underlying health conditions or mental health challenges?*

⭐ Anything else you would like to share?

🗓 Private Coaching Options

I offer private coaching in a few different formats, depending on the level of support you’re looking for.

Options include:

6-Week, 3-Month or 6-Month coaching programs
Life, alcohol-free and grief & loss support

During our Zoom intro call, we’ll talk through what you’re looking for and determine which option feels like the best fit for you right now. Full details are always shared before any commitment is made.

All One to One Coaching Packages Include:

• Weekly or bi-weekly sessions via zoom

• Access to your private client portal

• Ongoing accountability and support

• A personalized, tailored coaching plan

• Sustainable action steps

• Greater clarity and confidence

• Practical tools for growth

💛 Always sprinkled with a PMA (Positive Mental Attitude!)

Area of coaching support you're interested in:

Life

Alcohol-Free

Grief & Loss Support

I'm not sure yet (and that's totally welcome!)