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My coaching can be personalized, so be as detailed as possible in your responses.

Thank you for your interest in the Grit & Growth Program: Unlock the Mental Toughness Every Nurse Needs. Please complete this form to help us understand your unique needs and goals. All responses will be kept confidential.

Personal Information

First Name *

Last Name *

Phone *

Email *

Instagram Handle *

Nursing Role/Title:

Years of Experience in Nursing:

Work Environment:

(e.g., Emergency Department, ICU, Med-Surg, Outpatient, etc.)

Primary Shift (Day/Mids/Nights/Rotating):

What personal challenges, if any, are impacting your professional life?

How do you think these challenges are affecting your performance or satisfaction at work?

Goals & Expectations

What inspired you to join this program? *

What specific outcomes are you hoping to achieve by the end of this program? *

Are there particular areas where you would like to see improvement?

Managing stress more effectively

Building confidence in difficult situations

Communicating more assertively/effectively

Strengthening emotional intelligence

Enhancing overall work-like integration

Other

If other, please elaborate below:

Additional Information

What is your commitment level to your results? *

1. I’m extremely committed. I’m sick of my own bullshit, and I will do whatever it takes.

2. I’m committed enough to invest in my goals but I’m afraid of “missing out” on social events.

3. I know I need help to make a change but I’m not sure if I’m ready to fully commit.

Is there anything else you would like me to know about your situation, goals, or expectations for this program? *

Sarah S.

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Client Name

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