New Client Questionnaire Let's start at the beginning. Your answers help Jordan understand where you are and what you need. There are no wrong answers — only honest ones. The Basics First name * Your name Last name * Email address * where to reach you Phone / WhatsApp optional Time zone * Select... How did you find Jordan? Select... Where You Are Right Now What's going on for you right now that made you reach out? Don't overthink it — what came up that made you finally press send? Write as much or as little as feels right... How long have you been feeling this way? Select... Which of these resonates with you? Check all that apply. I feel like I'm living a life that isn't really mine I'm exhausted in a way that sleep doesn't fix I keep starting therapy that still feels empty or stuck I'm overextending everyone else, but I don't know what I actually need I'm functioning fine on the outside but quietly falling apart I'm just lost and I don't know who I even am anymore On a scale from 1–10, how would you rate your current level of overwhelm? 1 — I'm managing 10 — I'm barely holding on 5 What You're Hoping For If coaching with Jordan worked — really worked — what would be different? It's okay if this is fuzzy. What's the feeling you're looking for? Describe what 'better' looks like for you... What have you already tried that hasn't worked? Therapy, self-help books, other coaching, just pushing through... What do you most need from a coach right now? An accountability partner who asks the questions I can't ask myself Clear, direct feedback and honest pushback on my thinking Real space to think and process out loud without judgment Help building concrete next steps and a strategy to move forward Honestly, all of the above — whatever it takes to create real change A Little More Context What does a typical week look like for you right now? Work, caregiving, relationships, health — whatever feels relevant Give me a sense of your day-to-day world... Are you currently working with a therapist or mental health provider? No, I'm not Yes, I see them regularly No, but I'm actively looking for one right now I'd be open to it, but haven't started looking Anything else you want Jordan to know before your first call? Open space — say whatever feels important... Before You Submit Coaching Scope Acknowledgment Please read and confirm each statement below. All five are required before your form can be submitted. I understand that coaching with Jordan is not therapy and does not constitute mental health treatment, clinical counseling, or psychological services of any kind. I understand that coaching does not diagnose, treat, or address mental health conditions such as depression, anxiety disorders, trauma, or other clinical concerns. If a clinical condition is present, I will seek appropriate licensed professional support. I understand that Jordan does not provide therapist referrals or recommendations. If professional mental health support is needed, I am solely responsible for identifying and pursuing that care independently. I understand that if Jordan believes my needs are better suited to therapy or clinical support, she will tell me honestly — and I am open to that conversation. This does not create an obligation for Jordan to locate or recommend a provider on my behalf. I am entering this coaching relationship voluntarily, as a capable adult, and I take full responsibility for my own decisions, actions, and wellbeing throughout our work together. 5 statements remaining. Submit my intake form