Coaching with DrSheron!

Yes- I want online coaching with Dr. Sheron!

The online coaching contract must be signed and dated before the start of online coaching.

Payment must be made before the start of each online coaching session.

Payment is accepted via Cash App, Zelle, and Square.

One online counseling session is $150.00 The session is 45 minutes in length via ZOOM. Five sessions are bundled for cost savings at $500.00.

Each session is 45 minutes in length via ZOOM.

I am ordering ___ session (s) Amount Due $_____

Payment through CashAPP, Zelle, Square Please list 5 potential days and times that you are available for online coaching within the next seven days. ________________________ ________________________ ________________________ ________________________ ________________________

We will reach out to you soon.

Intake Client Form “GETTING TO KNOW YOU” Coaching is more effective and efficient if you can give me some information about yourself at the beginning. This is confidential information and you are free to not answer any of the questions. I encourage you to be open and share the information in order to get the most from our coaching relationship.

Name: Name you like to be called: Address: Phone: (Home)

(Work)

Phone: (Mobile)

(Fax)

E-mail address: Occupation: Employer’s name: Date of birth:

Marital status:

Significant Other’s Name: Names and ages of children: Name:

Page 1 of 7

Age: Name:

Age:

Life Satisfaction Questionnaire How satisfied are you with different areas of your life? Circle a number from 1 to 10 next to each of the following areas of life. If you give an item a 1, you are completely dissatisfied

with this part of your life. It means, “This part of my life is entirely unacceptable to me in its current state.” A number 10 means, “I couldn’t be happier or more satisfied with this

area of life.” Your overall satisfaction will change from day to day, but try to give an overall assessment of where you are at present.

1- Completely dissatisfied

10 – I could not be happier

Physical Health

Mental/Emotional Health

Career/Employment Satisfaction

Financial Stability

Marriage/Romantic Relationships

Home Life (Immediate Family)

Extended Family (Relatives, In-laws) Friends/Social Life

Recreation/Relaxation/Leisure

Lifestyle (Degree of Busyness and Life Balance)

Personal Life Fulfillment Spiritual Health/Life

Church/Religious Life

Physical Comfort (Housing, Neighborhood, Possessions, Cars, etc.)

Page 2 of 7

1. Why do you want coaching? Be as specific as possible. Example: “I want to start an exercise program to gain more energy and to lose 30 pounds.” Use extra paper if you wish.

2. Are you or have you ever been in counseling or therapy?

Yes

No

If yes, please explain.

3. Describe your spirituality. What is your relationship with God? In what ways do you sense God might be challenging you, nudging you in a different direction, or trying to get your attention.

Page 3 of 7

4. What are the most important things (good and bad) happening in your life right now?

5. In what ways would you like your life to be different one year from now? Be specific.

6. What is getting in the way of these goals?

Page 4 of 7

7. List at least three things you procrastinate at -- the things that you’ve been putting off.

8. What, if any, are your concerns about coaching?

9. Rate the level of stress in your life on a scale of 1 to 10. (1=low and 10=high) _____

10. What are your primary stressors?

Page 5 of 7

11. Why did you select me as your coach?

12. What would you like me to do if you get behind in progress toward your goals?

13. How do you like to be supported or held accountable?

Page 6 of 7

14. What else would you like me to know about you?

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

Page 7 of 7

Coaching Introduction to Client To help you become more familiar and comfortable with my coaching process:

•

•

You set the agenda in the coaching partnership based upon our mutual

understanding of your priorities. As your coach, I will hold you accountable.

My responsibility is to support, motivate, challenge and guide you. Your

responsibility is to take the action necessary to make the changes you want in your •

life.

I will ask you the tough questions, provide you with focus and structure, support

and encourage you through the difficult times. And, I will celebrate your successes

•

with you.

•

make the changes you desire.

•

should be taken to an appropriate qualified professional.

•

information about you to anyone unless permission is granted.

•

appreciated.

You will be asked to experiment with fresh approaches and strategies in order to Issues that are outside the boundaries of the coaching relationship and my expertise Confidentiality is paramount in the coaching relationship and I will not disclose any If you choose to discontinue the coaching relationship, a one month notice is Feedback is gratefully accepted. If you feel there is something I am doing that is not helpful for you or that I am not doing that would help you, please inform me.

•

The Christian faith is my compass for life. My hope is that you will enjoy an

abundant life as mentioned in verse John 10:10 of the Bible. My coaching comes •

from a Biblical perspective.

Coaching sessions will last approximately 45 minutes. The more direct and to the point we are in our conversation the more productive our sessions will be.

The goal of my coaching is to create a trusting and dynamic partnership to help you move toward a more satisfying and full life. I will use innovative and practical strategies to help you clarify what you want, explore options, enhance personal accountability and take action so that you can experience a more joyful life.

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

Christian Client Coachability Index Circle the number that most accurately represents how true the statement is for you right

now. Next, score yourself using the key below. Your coach needs you to be in the right

place in your life so that you are coachable and you are ready to achieve great results. This assessment helps him or her - as well as you - discover how coachable you are right now.

How coachable are you?

SCORING KEY:

1 - Not like me at all 2 - Sometimes 3 - Often

4 - Most of the time 5 – Very like me

3

1 1

1

1 1 1

I can be relied upon to be on time for all calls and appointments.

I am willing to be accountable to another person.

I am fully willing to do the work and let the coach do the coaching.

I am willing to eliminate or modify any self-defeating behaviors that may limit my

success.

I am a self-starter and am willing to take the action necessary to achieve my goals.

I will speak truth to the coach.

I am willing to work with my coach in a partnership.

1

1

I understand boundaries and actively set them in various areas of my life.

I understand that coaching is not counseling, consulting, or mentoring. Coaching is an ongoing partnership that will help me produce fulfilling results in my personal

1 1 1 1

1

1

and professional lives.

My Christian values are my moral foundation.

I am open to talking about my dreams, visions, and goals.

I am not afraid to take risks.

I have prayed about my goals and believe God is directing me.

I am willing to consider new ideas, behaviors, and values.

I have goals I want to achieve that have not yet been reached.

YOUR SCORE:

17

ANSWER KEY: 30 or less

You may not be ready to work with a coach at this time but your coach will

most likely have specific recommendations that fit your individual needs for now. Ask your coach about a few exercises that will help you to further

understand your own needs and how you may benefit from coaching in the 31-59 60-75

future.

Coachable

Very coachable; tell the coach to ask a lot from you!

Christian Coach Ethics and Guidelines As a Christian Coach: 1.

I hold myself accountable to the highest level of integrity, honoring Jesus Christ

2.

individually and corporately, in all my associations with clients and colleagues.

3.

law.

4.

structure, fees, refunds, expectations and guarantees.

5.

permission.

6.

respecting copyrights, trademarks and intellectual property.

7.

inform concerned parties of my position.

8.

areas of expertise.

9.

I will maintain complete confidentiality with my clients, within the confines of the I will be clear with my clients about the nature of the coaching relationship, including I will never give a client's name to anyone, for any purpose, without express I will give credit where credit is due for materials supplied by other sources, I will judiciously avoid conflicts of interest. If any should arise, I shall, without delay, I will represent myself honestly and clearly to my clients, and coach only within my I will actively pursue well-being, wholeness, and continual learning in my own life.

I will refer a client to another coach if I am not within my area of expertise or comfort, so the client gets the best possible coaching.

10. I will honor my Christian values in my professional conduct, placing neither blame nor blemish on the name of Christ, the Christian Coach Institute or the coaching profession.

Copied from Christian Coaches Network. All rights reserved.

Coaching Agreement Coaching is an ongoing relationship between a coach and a person who desires coaching. We both agree that: 1.

Coaching is not therapy, counseling, advice giving, mental healthcare, or treatment for substance abuse or any addictive behavior. The coach is not functioning as a licensed mental health professional, therapist or counselor, and coaching is not intended as a replacement for counseling, psychiatric interventions, treatment for mental illness,

recovery from past abuse, professional medical advice, financial assistance, legal counsel, 2.

or other professional services.

3.

fairly effectively, and wanting to make improvements in their lives.

Coaching is for people who are basically well adjusted, emotionally healthy, functioning Coaching is designed to address issues the person being coached would like to consider.

These could include (but are not limited to) personal foundation, career development,

relationship enhancement, spiritual growth, healthy lifestyle management, life balance, 4.

decision-making, and achieving short-term or long-term goals.

Coaching will be an ongoing relationship that may take a number of months, although

either party can terminate the relationship at any time. Some or all of the coaching may 5.

be through telephone contact.

Coaching can involve brainstorming, values clarification, the completion of written

assignments, education, goal-setting, identifying plans of action, accountability, making 6.

requests, agreements to change behavior, examining lifestyles, and questioning.

7.

communication.

Coaching is most effective when both parties are honest and straightforward in their If the coaching is to involve payment for services, prior to its beginning both parties will

agree to a fee, form of payment, procedures for canceled appointments, and initial length of commitment.

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

8.

Coaching is a confidential relationship and the coach agrees to keep all information

strictly confidential, except in those situations where such confidentiality would violate 9.

the law.

Coaching assumes that each person in the relationship is guided by his or her values and beliefs. Your coach is a follower of Jesus Christ and seeks to live in accordance with this commitment. Your coach is honest in making this revelation and respects the different values and beliefs of others. Your coach does not seek to impose his or her values on

another, proselytize, condemn, or refuse coaching services to people who do not share similar values and beliefs.

10. We agree to the following business arrangements: The monthly fee for (number of

sessions) (time for each session ex.45 minute) sessions is $_______. If I do not cancel any session with 24 hours notice I will forfeit the session fee.

11. I (the person being coached) am committed to creating an alliance with my coach, ______.

12. Each of the people whose signatures appear below agrees that this agreement represents our mutual understanding of the coaching relationship.

DISCLAIMER: The client is the sole decision-maker in the coaching process. Any and all

actions or consequences resulting from the coaching sessions are the responsibility of the

client. The client releases the coach of all liability pertaining to the services rendered in the coaching relationship.

_______________________________________________ Signature (client)

_________________________________ Date

________________________________________________ Signature (coach)

__________________________________ Date

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

Coaching

With Dr. Sheron

DrSheron.com

Coaching

With Dr. Sheron

Coaching With Dr. Sheron

Day Plan Plan

DrSheron.com

Individual Sessions For Individuals For Families For Groups

info@drsheron.com Scan Here

Intake Client Form “GETTING TO KNOW YOU” Coaching is more effective and efficient if you can give me some information about yourself at the beginning. This is confidential information and you are free to not answer any of the questions. I encourage you to be open and share the information in order to get the most from our coaching relationship.

Name: Name you like to be called: Address: Phone: (Home)

(Work)

Phone: (Mobile)

(Fax)

E-mail address: Occupation: Employer’s name: Date of birth:

Marital status:

Significant Other’s Name: Names and ages of children: Name:

Page 1 of 7

Age: Name:

Age:

Life Satisfaction Questionnaire How satisfied are you with different areas of your life? Circle a number from 1 to 10 next to each of the following areas of life. If you give an item a 1, you are completely dissatisfied

with this part of your life. It means, “This part of my life is entirely unacceptable to me in its current state.” A number 10 means, “I couldn’t be happier or more satisfied with this

area of life.” Your overall satisfaction will change from day to day, but try to give an overall assessment of where you are at present.

1- Completely dissatisfied

10 – I could not be happier

Physical Health

Mental/Emotional Health

Career/Employment Satisfaction

Financial Stability

Marriage/Romantic Relationships

Home Life (Immediate Family)

Extended Family (Relatives, In-laws) Friends/Social Life

Recreation/Relaxation/Leisure

Lifestyle (Degree of Busyness and Life Balance)

Personal Life Fulfillment Spiritual Health/Life

Church/Religious Life

Physical Comfort (Housing, Neighborhood, Possessions, Cars, etc.)

Page 2 of 7

1. Why do you want coaching? Be as specific as possible. Example: “I want to start an exercise program to gain more energy and to lose 30 pounds.” Use extra paper if you wish.

2. Are you or have you ever been in counseling or therapy?

Yes

No

If yes, please explain.

3. Describe your spirituality. What is your relationship with God? In what ways do you sense God might be challenging you, nudging you in a different direction, or trying to get your attention.

Page 3 of 7

4. What are the most important things (good and bad) happening in your life right now?

5. In what ways would you like your life to be different one year from now? Be specific.

6. What is getting in the way of these goals?

Page 4 of 7

7. List at least three things you procrastinate at -- the things that you’ve been putting off.

8. What, if any, are your concerns about coaching?

9. Rate the level of stress in your life on a scale of 1 to 10. (1=low and 10=high) _____

10. What are your primary stressors?

Page 5 of 7

11. Why did you select me as your coach?

12. What would you like me to do if you get behind in progress toward your goals?

13. How do you like to be supported or held accountable?

Page 6 of 7

14. What else would you like me to know about you?

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

Page 7 of 7

Coaching Introduction to Client To help you become more familiar and comfortable with my coaching process:

•

•

You set the agenda in the coaching partnership based upon our mutual

understanding of your priorities. As your coach, I will hold you accountable.

My responsibility is to support, motivate, challenge and guide you. Your

responsibility is to take the action necessary to make the changes you want in your •

life.

I will ask you the tough questions, provide you with focus and structure, support

and encourage you through the difficult times. And, I will celebrate your successes

•

with you.

•

make the changes you desire.

•

should be taken to an appropriate qualified professional.

•

information about you to anyone unless permission is granted.

•

appreciated.

You will be asked to experiment with fresh approaches and strategies in order to Issues that are outside the boundaries of the coaching relationship and my expertise Confidentiality is paramount in the coaching relationship and I will not disclose any If you choose to discontinue the coaching relationship, a one month notice is Feedback is gratefully accepted. If you feel there is something I am doing that is not helpful for you or that I am not doing that would help you, please inform me.

•

The Christian faith is my compass for life. My hope is that you will enjoy an

abundant life as mentioned in verse John 10:10 of the Bible. My coaching comes •

from a Biblical perspective.

Coaching sessions will last approximately 45 minutes. The more direct and to the point we are in our conversation the more productive our sessions will be.

The goal of my coaching is to create a trusting and dynamic partnership to help you move toward a more satisfying and full life. I will use innovative and practical strategies to help you clarify what you want, explore options, enhance personal accountability and take action so that you can experience a more joyful life.

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

Christian Client Coachability Index Circle the number that most accurately represents how true the statement is for you right

now. Next, score yourself using the key below. Your coach needs you to be in the right

place in your life so that you are coachable and you are ready to achieve great results. This assessment helps him or her - as well as you - discover how coachable you are right now.

How coachable are you?

SCORING KEY:

1 - Not like me at all 2 - Sometimes 3 - Often

4 - Most of the time 5 – Very like me

3

1 1

1

1 1 1

I can be relied upon to be on time for all calls and appointments.

I am willing to be accountable to another person.

I am fully willing to do the work and let the coach do the coaching.

I am willing to eliminate or modify any self-defeating behaviors that may limit my

success.

I am a self-starter and am willing to take the action necessary to achieve my goals.

I will speak truth to the coach.

I am willing to work with my coach in a partnership.

1

1

I understand boundaries and actively set them in various areas of my life.

I understand that coaching is not counseling, consulting, or mentoring. Coaching is an ongoing partnership that will help me produce fulfilling results in my personal

1 1 1 1

1

1

and professional lives.

My Christian values are my moral foundation.

I am open to talking about my dreams, visions, and goals.

I am not afraid to take risks.

I have prayed about my goals and believe God is directing me.

I am willing to consider new ideas, behaviors, and values.

I have goals I want to achieve that have not yet been reached.

YOUR SCORE:

17

ANSWER KEY: 30 or less

You may not be ready to work with a coach at this time but your coach will

most likely have specific recommendations that fit your individual needs for now. Ask your coach about a few exercises that will help you to further

understand your own needs and how you may benefit from coaching in the 31-59 60-75

future.

Coachable

Very coachable; tell the coach to ask a lot from you!

Christian Coach Ethics and Guidelines As a Christian Coach: 1.

I hold myself accountable to the highest level of integrity, honoring Jesus Christ

2.

individually and corporately, in all my associations with clients and colleagues.

3.

law.

4.

structure, fees, refunds, expectations and guarantees.

5.

permission.

6.

respecting copyrights, trademarks and intellectual property.

7.

inform concerned parties of my position.

8.

areas of expertise.

9.

I will maintain complete confidentiality with my clients, within the confines of the I will be clear with my clients about the nature of the coaching relationship, including I will never give a client's name to anyone, for any purpose, without express I will give credit where credit is due for materials supplied by other sources, I will judiciously avoid conflicts of interest. If any should arise, I shall, without delay, I will represent myself honestly and clearly to my clients, and coach only within my I will actively pursue well-being, wholeness, and continual learning in my own life.

I will refer a client to another coach if I am not within my area of expertise or comfort, so the client gets the best possible coaching.

10. I will honor my Christian values in my professional conduct, placing neither blame nor blemish on the name of Christ, the Christian Coach Institute or the coaching profession.

Copied from Christian Coaches Network. All rights reserved.

Coaching Agreement Coaching is an ongoing relationship between a coach and a person who desires coaching. We both agree that: 1.

Coaching is not therapy, counseling, advice giving, mental healthcare, or treatment for substance abuse or any addictive behavior. The coach is not functioning as a licensed mental health professional, therapist or counselor, and coaching is not intended as a replacement for counseling, psychiatric interventions, treatment for mental illness,

recovery from past abuse, professional medical advice, financial assistance, legal counsel, 2.

or other professional services.

3.

fairly effectively, and wanting to make improvements in their lives.

Coaching is for people who are basically well adjusted, emotionally healthy, functioning Coaching is designed to address issues the person being coached would like to consider.

These could include (but are not limited to) personal foundation, career development,

relationship enhancement, spiritual growth, healthy lifestyle management, life balance, 4.

decision-making, and achieving short-term or long-term goals.

Coaching will be an ongoing relationship that may take a number of months, although

either party can terminate the relationship at any time. Some or all of the coaching may 5.

be through telephone contact.

Coaching can involve brainstorming, values clarification, the completion of written

assignments, education, goal-setting, identifying plans of action, accountability, making 6.

requests, agreements to change behavior, examining lifestyles, and questioning.

7.

communication.

Coaching is most effective when both parties are honest and straightforward in their If the coaching is to involve payment for services, prior to its beginning both parties will

agree to a fee, form of payment, procedures for canceled appointments, and initial length of commitment.

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001

8.

Coaching is a confidential relationship and the coach agrees to keep all information

strictly confidential, except in those situations where such confidentiality would violate 9.

the law.

Coaching assumes that each person in the relationship is guided by his or her values and beliefs. Your coach is a follower of Jesus Christ and seeks to live in accordance with this commitment. Your coach is honest in making this revelation and respects the different values and beliefs of others. Your coach does not seek to impose his or her values on

another, proselytize, condemn, or refuse coaching services to people who do not share similar values and beliefs.

10. We agree to the following business arrangements: The monthly fee for (number of

sessions) (time for each session ex.45 minute) sessions is $_______. If I do not cancel any session with 24 hours notice I will forfeit the session fee.

11. I (the person being coached) am committed to creating an alliance with my coach, ______.

12. Each of the people whose signatures appear below agrees that this agreement represents our mutual understanding of the coaching relationship.

DISCLAIMER: The client is the sole decision-maker in the coaching process. Any and all

actions or consequences resulting from the coaching sessions are the responsibility of the

client. The client releases the coach of all liability pertaining to the services rendered in the coaching relationship.

_______________________________________________ Signature (client)

_________________________________ Date

________________________________________________ Signature (coach)

__________________________________ Date

Copied from Gary R. Collins, Used by permission of NavPress (www.navpress.com). All rights reserved.

CHRISTIAN COACHING: Helping Others Turn Potential into Reality, 2001