Relaxation and Stress-reduction Session with Rebecca

Please use this form to schedule your first session with me.

You did it! You're here, you're ready.

Where inspiration meets action, therein lies the key to all transformation.

And it starts with a single step.

-Rebecca

Welcome! I am honored and grateful that you have taken this first step to scheduling your Relaxation and Stress-reduction session. This short questionnaire will help me understand more about you and how I can be of of help.

Relax and unwind in the warm caring presence of Master Coach and Mindfulness Instructor Rebecca Cooley:
-During each gentle session, Rebecca listens deeply to what you are needing at this time.
-She then wraps you in a cozy blanket for a seated or reclining customized session.
-With soft relaxing music and aromatherapy, she offers guided mindfulness-based stress reduction as well as guided imagery and meditation.
-She leads you in soothing verbal and visual affirmations.
-And creates space for you to connect deeply with yourself and helps you create a loving doorway for your own self-care.

(Please add @rebeccacooley.com to your address book to ensure that you receive important emails from me.)

I look forward to meeting you soon!

Wishing you much peace and joy,
~Rebecca Cooley

Certified Master Coach and Mindfulness Instructor

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* 1. Contact information

Name:

Occupation:

Age:

Address:

City/Town:

State:

Zip code:

Email Address:

Phone Number:

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* 2. Why now? Why have you decided to reach out at this time? What do you hope to gain from your Session with me?

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* 3. What is this one big thing that is getting in the way?

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* 4. Fast forward 12 months from now, what is needed for you to experience more peace, joy, and freedom if you received help with that?

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* 5. What strategies have you taken so far to address any challenges you are facing? (check all that apply)

Classes

Individual or Group Counseling or Therapy

Independent Study

Other Relaxation Methods

None of the above

Other (please specify)

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* 6. After the session, what will you do to continue to nourish yourself?

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* 7. Which areas are you currently seeking to improve? (check all that apply)

Transformation and Personal Change

Increased Motivation

Balance

Self-awareness

Stress-reduction, Relaxation

Improved Relationships

Confidence/Assertiveness

Personal Empowerment

Peace

Present Moment Living

My Life's Purpose

Happiness and Joy

Getting unstuck and unblocked

Navigating life as an empath

Setting boundaries

Feeling my Feelings

Expressing my feelings

Emotional Eating

Other (please specify)

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* 8. Each of our sessions together will include guided meditation, mindfulness-based stress reduction, imagery and affirmations. If there are additional services that you want included in your session, please indicate them here. I will do my best to include what I can within the time frame. (check all that apply)

EFT-Emotional Freedom Technique (also known as tapping, psychological acupressure)

Mindfulness Training

Healing Your Relationship with Food

Various Other Natural and Alternative Methods for Relaxation and Stress-reduction

Expressive Art (Mandala artwork- you don't have to be an artist for this method)

Self-compassion Training (Reducing negative self-talk)

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* 9. Which keywords did you use to search for us? (ex. stress release Raleigh, relaxation, mindfulness, etc)

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* 10. Please use this link to schedule your Relaxation Session.
IMPORTANT: Remember to return to this page and submit your form prior to scheduling. Thank you.

*Please know that this offering does not come with a guarantee as results may vary. This is not a coaching session. I offer my coaching programs as 3-month private coaching programs which include private coaching sessions, a Master Course and additional support to ensure that my partners have everything they need from me to have mindset breakthroughs and learn skills. I have found that the allotted 3-month program time is what is needed to make lasting change toward intrinsic goals such as confidence, reduced nervousness, fear-reduction. I look forward to offering you the very best I can in this short time. If after session, you decide that you would like to enroll in one of my private or group coaching programs to make further progress or gain mastery, I am happy to share more. I look forward to helping you in any way I can.

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