Checklist

RECLAIM YOUR HEART

This will help you:

Challenge and rewire the negative thoughts that hold you back.

Replace self-doubt with God’s truth about who you are.

Learn simple self-love habits that you can start right now.

Release guilt, open your heart, and step into confidence.

Your future self will thank you!

Download Today

SECTION 1: PERSONAL INFORMATION

First name

Last name

Email

Phone

Address

Preferred Contact Method:

Email

Text

Call

Either Works

SECTION 2: YOUR HEALING JOURNEY

What prompted you to reach out for coaching at this time?

How would you describe your current emotional state in one word?

What are you hoping to gain or experience through one-on-one coaching?

Have you ever worked with a life coach, counselor, or mentor before?

Yes

No

If yes, what was most helpful or least helpful about that experience?

SECTION 3: YOUR READINESS & SUPPORT

How willing are you to commit time and emotional energy toward your healing process?

Very willing

Somewhat willing

Unsure

Do you currently have a support system (friends, family, church, community)?

Yes

Somewhat

Not right now

How do you typically process emotional pain? (Check all that apply)

What does healing in real time look like to you personally?

SECTION 4: FAITH & PURPOSE

Describe your current relationship with God.

How does your faith influence your healing journey?

What does “living in divine alignment” mean to you?

SECTION 5: NEXT STEPS

Which of the following are you interested in learning more about?

How soon are you looking to begin coaching?

Immediately

Within the next month

In the next 3 months

Is there anything else you’d like Mechelle to know before your session?

By submitting this form, I acknowledge that I’m taking a brave step toward healing and wholeness. I understand that Mechelle Renee’s coaching is faith-based and focused on emotional wellness, purpose, and spiritual alignment.