Mentoring Intake Form

Welcome to our Mentoring Intake Form. This form is a tool we strongly recommend you use when scheduling a single mentoring session or when starting a comprehensive monthly mentoring program with Michael. While we don't require it, we've found it help cut down on the amount of time spent "getting up to speed" during the initial and individual mentoring sessions. That just means you'll have more time to spend discussing key issues and finding practical solutions.

So please answer the 10 questions below to the best of your ability and submit your responses at least a day before your first scheduled session with Michael. Feel free to skip any questions you'd rather not answer. All information you share both here and during your live sessions with Michael is treated as private and confidential. Thanks for taking the time to do this.

*(denotes required field)

Name: *

E-Mail Address: *

1. Please describe the problem or situation that you're seeking help for?

2. What do YOU think are the main underlying issues or causes of this problem?

3. Have you sought out help or advice from others for this before? If so, from whom (i.e. friend, counselor, pastor) and what were the results?

4. Why have you come to Michael for help now? What are your expectations of him as your mentor?

5. What are the 3 biggest questions you have about your problem or situation?

6. If you could "fix" anything about your partner or spouse (assuming you see them as part of the problem), what would it be?

7. Michael sees people as whole human beings: mind, body, and spirit or soul. How would you describe you spiritual condition right now? What about your partner's? Would you like Michael to advise you on any issues he recognizes as spiritually-related during your mentoring time together?

8. Is there anything else you'd like to share here about yourself (family background, past abuse, etc.) or this problem or issue before your mentoring session with Michael?

9. Are you seeing a professional counselor or therapist for this problem now, or do you plan to in the near future?

10. What's the best phone number Michael should use to reach you? Any restrictions (i.e. don't call me in the evenings, don't call during work hours, etc.)?

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