CRC Life Coach information form

Step one: Breathe deep and relax.
Step two: Please share some information about yourself.

In order to be able to concentrate our collective time in the most efficient way possible, we at CRC Life Coach would like you to fill out this form to the best of your ability.  Some of the answers to these questions may depend a lot on the mood you're in at any one time.  If that is the case, please answer them as if there were no emotional/mental/financial repercussions... as if you had no pressure whatsoever, no matter what decision you made.  There are no wrong answers.  As such, we ask that you spend as much time as you need to go through this.  Please DO NOT rush through this.  There is no prize for getting this done the quickest.  Not only does this better understand you so that we can best help, but often it helps you understand you.  So please, sit back, relax and take your time.
Step three: Please submit this information at least two days before setting up your first session.

Since we want you to be able to complete this as fully, honestly and as stress free as possible, if you cannot complete and submit this 2 days in advance, we would rather have you push back your first session, rather than having you rush through this.  We want to be able to set up a profile for you and do a quick pre-analysis of your current desires and goals so that we can better understand and, in turn, hit the ground running to help you achieve your goals.
Step four: Breathe deep and relax.
A note from your CRC Life Coach

Thank you for allowing me to get to know you and have the opportunity to build a relationship so that, hopefully, we can become friends as well as coach and client.  We can never have too many friends!

Looking forward to getting to know you,

Russell Church, CHC, LRMT
​Founder,
CRC Life Coach

    Part 1: Contact information (No information is shared with anyone EVER, and we will not send you unsolicited email):

    Part 3: Goals and expectations

    ***THE FOLLOWING QUESTIONS PERTAIN TO YOUR TOP PRIORITY ONLY***

    ***THE FOLLOWING QUESTIONS PERTAIN TO YOUR SECOND PRIORITY ONLY***

    Part 4: General Satisfaction

    The following questions are dig down deep in your heart kind of questions that we want you to seriously think about before answering.  Consider how you would answer if there were no one to judge your response.  If after thinking about it, you decide that 10 minutes of alone time in the bathroom stall at work is better than 2-3 hours spent at home with your spouse and family in the evening, please be honest.  We don't judge and we need to know these things in order to help make life more joyful for you.  Please be aware though that it is our goal to make the home time more enjoyable, not to extend your stall time.  :)  Just remember, there are no right or wrong answers, only honest or dishonest ones.

    Part 5: Commitment (THIS IS THE MOST IMPORTANT!)

    Are you TRULY ready to make changes that will positively affect your life in a positive way?
    Change can be extremely difficult, especially when we have building habits and perceptions for long periods, sometimes for our entire lives.  CRC Life Coach is not interested in taking peoples money or wasting your or our time for services that will not make long term lasting benefits for you.  We realize our services are not inexpensive and are convinced that you must be truly ready to dedicate the time and money to make permanent and lasting changes in your life.
    If you are ready to commit to changing, knowing that sometimes we must destroy old habits, patterns and beliefs in order to build a better life for ourselves, then PLEASE continue by acknowledging below.

    I understand that CRC Life Coach takes no liability whatsoever for any advice given by them.  All advice is given with the best of intention, cannot be misconstrued as anything other than that and is the clients full responsibility to either choose to follow such advice given.  CRC life coaches are not certified medical or counseling professionals, unless otherwise stated and will not provide medical advice of any kind, although they may be suggested or referred to such.
    Please be aware that if, after evaluation, CRC Life Coach determines that more professional advice is required, we will state this and suggest this path before accepting you as a new client.


    I Acknowledge the above