Boundaries intake form - Amal Jomaa - Coach de vie développement personnel certifiée / Certified Personal Development Life Coach

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Welcome to the Boundaries Workshop Intake Form

Thank you for joining the Boundaries Workshop. This form is designed to help me understand where you are, what you struggle with, and how I can support you in the most effective, personalized way.

There are no right or wrong answers. Simply answer honestly and gently. Everything you share stays confidential and helps me tailor the coaching sessions to your needs.

Let's get to know you

* Indicates required field

Name *

First

Last

Email *

Phone Number *

How did you hear about this workshop? *

1. Your Relationship With Boundaries

How would you describe your current ability to set boundaries? *

I’m comfortable and confident I try, but I struggle I avoid setting boundaries I’m not sure

What comes up for you when you try to set a boundary? *

Stress Guilt Fear of disappointing others Confusion about what’s “too much” Other

2. Current Patterns

Do you tend to (select all that apply): *

Overgive Say yes when you mean no Keep quiet to avoid conflict Take on other people’s emotions Feel responsible for people’s reactions Feel drained after interactions Feel resentful after helping others

What is one recent situation where you wished you had set a clearer boundary? *

3. What You Want to Gain

What motivated you to join this workshop now? *

What do you hope to learn or improve by the end of the workshop? *

Speaking up Staying calm when setting boundaries Saying no without guilt Managing time and energy Handling difficult conversations Feeling more confident Understanding my needs Other (please explain)

Are there specific scenarios you’d like support or examples for? *

4. How I Can Support You Best

What kind of support works best for you? *

Clear step by step guidance Real-life examples Practical scripts and phrases Role-play style practice (non-immersive) Worksheets Group discussion A mix of everything

Do you have any concerns or worries about the workshop? *

Is there anything else you'd like me to know so I can support you more effectively? *

Thank You
Thank you for taking the time to complete this form. Your honesty and openness help me understand how to support you in the best possible way. I’m grateful you’re here, and I’m looking forward to guiding you toward clearer boundaries, more confidence, and healthier connections.

I’m excited to work with you and support you throughout this journey.

Submit

Looking forward to hearing from you!

Hours

M-F: 9am - 9pm

Telephone

+1 514-813-7139

Email

[email protected]

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