Positive Break Call us:205-621-9524
Don't let your past
dictate who you are,
but let it be a lesson
that strengthens the
Person you will become.
Spouse/ Partner Name if any:
If we are unable to reach you, can we contact your spouse/ partner?
Employer Name and Company Name:
Emergency Contact Information:
Referent - Who referred you?
Describe the Problem that brought you here:
Please check all the behaviors or symptoms that you consider problematic:
Are your problems affecting any of the following:
If you are not serious, please don't fill out the intake form. Our coach is a professional and her time is very valuable. We support you in achieving your goals and living a fulfilling life
My aims to help you achieve clarity and confidence to work through issues that are holding you back so you can enjoy a harmonious life.
A - Coaching Relationship invites a safe, sacred space for exploring life. Experiences and making a purposeful difference in the areas of your life, you hold important the key.
Identify your values, strength and goals. Create an efficient time management system
Thrive in time of transition manage stress.
Look within for the answers, the noise outside is just that!