Name *
E-Mail *
Are you completing this questionnaire as:
An individual
As a couple (together)
As a couple (separately)
If completed separately, responses will be reviewed individually and honored with care.
What work have you already completed?
(Check all that apply)
Individual coaching
Couples coaching
Counseling or therapy
Faith-based program or class
Personal growth or healing program
Other (short answer):
What growth or progress are you most proud of right now?
In what ways do you notice yourself staying stronger than you once did?
(Check all that apply)
Improved communication
Greater emotional awareness
Clearer boundaries
Increased confidence
Better conflict navigation
Stronger faith or inner grounding
More peace in daily life
Other (short answer):
Where do you feel most vulnerable to slipping back into old patterns?
What tends to challenge your resilience the most right now?
(Check all that apply)
Stress or overwhelm
Life transitions or uncertainty
Emotional triggers
Communication breakdowns
Fatigue or burnout
Fear of conflict
Losing focus or intentionality
Other (short answer):
When things feel off, how quickly do you typically notice and respond?
Very quickly – I catch myself early Somewhat quickly – I notice after a little time Slowly – I often realize it later I’m still learning to recognize it
What kind of support would be most helpful for you in this season?
(Check all that apply)
Accountability and check-ins
Gentle guidance and encouragement
Tools to stay aligned with my values
Help course-correcting when I feel off
A safe space to process challenges
Continued growth without intensive coaching
How would you describe your current season?
What does “staying resilient” mean to you personally?
What would success look like for you in the next 3–6 months?
Are you willing to engage with reflection, honesty, and gentle accountability as part of this maintenance process? Yes Mostly (with grace) I’m open and willing to grow
Is there anything else you’d like me to know as we consider Resilience Coaching together?
Resilience is not about fixing what’s broken—it’s about honoring the work you’ve already done and choosing to protect it. Thank you for taking the time to reflect and share honestly.
