Contact Information *

First Name

Last Name

Phone *

(###)

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Help us match you with the right Coach for you by telling us about your preferences. First, would you prefer a male or female coach? *

Male

Female

No Preference

If you could only pick one superpower for your coach what would it be? *

Incredible Listener

Amazing Motivator

A+ Actionable Advice

Calm, Cool, & Collected Coach

Accountability!

Your Biggest Fan & Cheerleader

Have you ever worked with a mental health coach, therapist, or counselor in the past? *

Yes

No

Emergency Contact Information *

First Name

Last Name

Phone *

(###)

###

####

I understand that this is not therapy. Your Corner coaches will never act under their license, provide a diagnosis, treat mental illness, or prescribe medication. Your Corner is not a substitute for therapy. We are focused on personal growth. This looks like setting specific and measurable goals, tracking progress, receiving guidance & accountability, and celebrating wins. Clients are ultimately responsible for their decisions and any resulting outcomes. Although Your Corner coaches are not acting under their licensure, they are qualified and expected to recognize if/when Clients may need to be recommended to an alternate or supplementary support option. Upon recognizing any need for support that is out of scope for Your Corner’s services, Coaches may connect Clients to Your Corners’ internal Care Concierge team for assistance in identifying appropriate care options. *

Yes

No