For your online intake

90 Days of Joy
Intake Questionnaire

A few sentences per question are enough. You may skip any question. You don't need to describe difficult experiences here; we'd rather discuss those in person.

Your details and starting point

Name Email address Phone number

Why do you want to join this program now?

What would you most like to change in your daily life?

How much energy do you have right now, on a scale of 1 to 10?

What helps you feel calm and enjoy life right now?

The Eight Themes

These questions introduce the themes we explore in the program. Take note of what resonates with you. During the intake session, we’ll discuss where you’d like to be at the end of the 90 days.

01 Come Home to Yourself

When do you put other people’s needs before your own?

02 From Surviving to Making Conscious Choices

How do you usually react when you feel stressed?

03 The courage to stay true to yourself

Which feeling do you tend to avoid?

04 Speak up and protect your boundaries

When do you find it difficult to clearly express what you need?

05 Stay in touch with your feelings without shutting down

What helps you stay present when a feeling becomes intense?

06 Recognize the pattern and choose a different response

Which pattern in your behavior would you like to break?

07 What Is Yours to Carry

Which role from your family or past do you still carry with you?

08 Live the life you choose

Which new habit do you want to keep up after these 90 days?

Your focus for the intake

Which two topics need your attention the most right now?

Where would you like to be at the end of the 90 days?

Is there anything about your health, nutrition, exercise, or the juice cleanse that you'd like to discuss with me?

What do you need to feel comfortable in the online group?

Which question would you like to bring up during our intake session?

I explicitly consent to the processing of my answers, including information about my health, nutrition, and exercise, in preparation for our intake session. I may withdraw my consent by emailing info@nicole-coaching.nl. Please also read the Terms and Conditions.

Your answers will be saved to help prepare for the intake and will only be visible to this website’s administrator. Please also read the Privacy Policy. Please save the difficult experiences for our conversation.

90 Days of Joy
Intake Questionnaire

01 Come Home to Yourself

02 From Surviving to Making Conscious Choices

03 The courage to stay true to yourself

04 Speak up and protect your boundaries

05 Stay in touch with your feelings without shutting down

06 Recognize the pattern and choose a different response

07 What Is Yours to Carry

08 Live the life you choose

Nicole Coaching

Discover

Take your first step

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90 Days of JoyIntake Questionnaire

01 Come Home to Yourself

02 From Surviving to Making Conscious Choices

03 The courage to stay true to yourself

04 Speak up and protect your boundaries

05 Stay in touch with your feelings without shutting down

06 Recognize the pattern and choose a different response

07 What Is Yours to Carry

08 Live the life you choose

Nicole Coaching

Discover

Take your first step

Archives

Categories

Pages

Categories

Archive

90 Days of Joy
Intake Questionnaire