**PEACE POWER EASE IMPACT EQUUS - A GROUP EQUUS COACHING EXPERIENCE**

INTENTION SETTING PRE-WORK

This questionnaire will serve as an opportunity for Kelly Eide to get to know you and your present life situation better with the goal of making your time with the horses as effective and meaningful as it can possibly be. It's also a great opportunity to you to be intentional about why you are choosing to go on this Equus Coaching journey.

Please read the following questions carefully and answer them as honestly as possible. Share whatever you feel comfortable expressing. Your responses will always be kept strictly confidential.

NAME

First Name

Last Name

PHONE NUMBER

Country

(###)

###

####

YOUR SESSION START DATE

YYYY

WHAT INSPIRED YOUR DECISION TO SIGN UP FOR THIS EQUUS COACHING JOURNEY?

PERSONAL INFORMATION

These questions are intended to elicit the most important things your coach should know about you right now. Please share whatever you feel comfortable expressing about the following. If your session is in a group, your answers will always remain confidential, even during your session which means that if you do not introduce the subject, I will not either:

YOUR CHILDHOOD OR UPBRINGING: HOW DO YOU CURRENTLY FEEL ABOUT IT? WHAT WAS/IS YOUR RELATIONSHIP WITH EACH OF YOUR PARENTS/CARETAKERS LIKE?

YOUR INTERESTS/ HOBBIES AS A CHILD: WHAT WERE THEY? WHAT INTERESTS/ HOBBIES DO YOU CURRENTLY HAVE?

IF YOU ARE CURRENTLY IN AN INTIMATE RELATIONSHIP (DATING, MARRIED, DIVORCED, ETC.) PLEASE DESCRIBE THIS RELATIONSHIP AND HOW YOU FEEL ABOUT IT, FROM YOUR PERSPECTIVE. IF YOU ARE CURRENTLY SINGLE PLEASE DESCRIBE HOW YOU FEEL ABOUT IT.

IF YOU ARE YOU CURRENTLY EMPLOYED? PLEASE DESCRIBE YOUR CURRENT SITUATION AND HOW YOU FEEL ABOUT IT, FROM YOUR PERSPECTIVE.

PLEASE LIST UP TO 3 EVENTS/RELATIONSHIPS/EXPERIENCES IN YOUR PRESENT LIFE THAT YOU ARE ENJOYING.

PLEASE LIST UP TO 3 EVENTS/RELATIONSHIPS/EXPERIENCES IN YOUR PRESENT LIFE THAT YOU FEEL ARE STRESSFUL OR THAT YOU FEEL YOU ARE STRUGGLING WITH.

LOOKING AT LIFE CYCLICALLY, WHAT AREAS ARE GROWING IN YOUR LIFE? WHAT IS DORMANT? WHAT IS PERHAPS STUCK?

HORSE EXPERIENCE

HAVE YOU EVER HAD ANY INTERACTION WITH HORSES? (OWNED? RIDDEN? PETTED?) IF SO PLEASE DESCRIBE:

DO YOU HAVE ANY FEARS ABOUT BEING AROUND HORSES?

DO YOU HAVE ANY PHYSICAL LIMITATIONS OR INJURIES?

DISCLOSURE OF CONCURRENT TREATMENT

ARE YOU CURRENTLY IN TREATMENT OR CONSULTING WITH ANY BEHAVIORAL HEALTH OR MEDICAL TREATMENT PROFESSIONAL? ARE YOU TAKING ANY MEDICATION?

WHAT WOULD BE THE BEST POSSIBLE OUTCOME FROM YOUR EQUUS EXPERIENCE?

DO YOU HAVE ANY QUESTIONS OR CONCERNS SURROUNDING THIS EXPERIENCE?

IS THERE ANYTHING FURTHER YOU WOULD LIKE ME TO KNOW THAT YOU THINK IS RELEVANT?

I look forward to sharing the PEACE POWER EASE IMPACT EQUUS Group Equus Coaching Experience with you.

Welcome to the Herd.