Coaching Questions from Jan Silvious

Thank you for contacting me for coaching! In our sessions, we will seek to discover God’s plan for you through the use of powerful questions, intensive listening and respect for your free-will. My goal is to lead you to make the choices needed to move to the next level of your life.

Please answer and return the following questions before our first session. It will help the coaching process get off to a quicker, smoother start.

Please answer and return the following questions before our first session. It will help the coaching process get off to a quicker, smoother start. *

Please state the issue about which you would like to be coached. What is the most challenging part of this issue for you? *

What do you want to see happen in your coaching? *

What are your expectations for yourself? *

What are your expectations for me as your coach? *

What dates will you be available for your first coaching session? *

The Center for Mind-Body Medicine

Jan Silvious, Life Coach
7030 Lee Highway Suite 201
Chattanooga, Tn. 37421
423 553 9995

“A change of perspective can change your life.”

Name *

City *

State *

Phone *

Skype

Email *

I agree to payment of $120.00 for a 90 minute coaching session, due at the end of the session. *

In-office coaching is payable by cash, check, or credit card.

Phone, Skype or Face Time coaching is payable by check or PayPal

I understand that coaching is not psychotherapy.
I agree to be responsible for my own choices and decisions during our coaching work together.

I understand that life coaching is a comprehensive process that may involve all areas of my
life, including work, finances, health, relationships, education and recreation. I acknowledge
that deciding how to handle these issues and implement my choices is exclusively my choice
and responsibility.

I understand that I must consult with any psychotherapist I may currently be working with
regarding the advisability of working with a life coach at this time.
I understand that information will be held confidential unless I state otherwise, in writing, as
required by law.
I have read and agree to the above:

Name *

Date *