Affirm Your Worth Intake Form | I AM Her Coaching

top of page

Home
My Testimony
Work with Me
FREE Resources
Shop
Salvation
Contact Me
More

Use tab to navigate through the menu items.

This Week’s Scripture

“If anyone is in Christ, the new creation has come.” — 2 Corinthians 5:17

Join the Sister Circle

Connect on Social Media

"A Word for Her"
A Weekly Devotional, delivered straight to your inbox

Join the Sister Circle

I Am Her: Affirm Your Worth

Welcome, beautiful one. 🤍

I’m so glad you’re here. This intake form will help me learn more about where you are right now and what you would like to focus on during your 1:1 Affirmation Session.

First name*

Last name*

Email*

Phone

What area of your life would you most like to focus on during our session? Checkboxes — Select all that apply*

Self-worth

Self-love

Confidence

Healing

Relationships

Boundaries

Letting go

Identity

Purpose

Faith

Personal growth

Peace

What is something you have been struggling to believe about yourself?*

Are there any negative thoughts or beliefs you find yourself repeating about yourself?*

What would you like to believe about yourself that you don't fully believe yet?*

Complete this sentence: “I want to become the woman who…”*

What is one area where you know you need to start choosing yourself?*

Are you a Christian*

Yes

Please acknowledge the following:*

I understand that the I Am Her: Affirm Your Worth Session is a coaching/self-development service and is not counseling, psychotherapy, mental health treatment, or a substitute for professional mental health care.

I understand that the purpose of this session is personal reflection, encouragement, affirmation development, and self-love/faith-based growth.

I understand that the information I provide will be used to help personalize my session and workbook experience.

Client Name:*

Date:*

Call

407-569-8211

I’d love to hear from you! Whether you’re asking a question or just want to connect, I’m here to help. Fill out the form below, and I’ll get back to you as soon as possible.

First Name

Last Name

Briefly describe your needs or what you're seeking help with

Thanks for submitting!

Connect on Social Media

Email

iamhercoaching@gmail.com

Contact Me

bottom of page