COMMUNICATION QUESTIONNAIRE

Please complete this questionnaire a week before our first session (if possible). The more care you take with it, the more I will be able to address your specific needs.

Communication in this questionnaire means what you need it to mean, and can include your ease or challenges in expressing or in communicating in specific situations or with specific people, your ability to communicate any aspect of human experience, and/or anything else you believe is relevant.

Please skip questions that don’t feel relevant, and don’t reveal anything you don’t want to reveal.
I will keep the information you share confidential.

Name

First Name

Last Name

Why do you want communication coaching?

How did you hear about Saul? If there was anything specific that interested you initially, what was it?

What prior communication training, if any, have you had? How did that training work for you?

What prior bodywork/exercise/sports/meditation/voice training, if any, do you have? How did that training work for you?

Do you have any injuries or conditions (physical or emotional) that limit what you do or what we could do? What, if any, advice have you received about this from a medical doctor, therapist, or other professional?

Examples: I twisted my knee 6 months ago and it only hurts rarely now. I tend to have generalized lower back pain. I get panic attacks. I was in a car accident last week and my neck is a little sore. I have TMJ/vocal nodules/asthma. I struggle with depression and prefer not to be emotional. I am pregnant.

What do you like or enjoy about how you communicate?

Is there anything related to communication that might limit you or make it difficult to realize your personal or professional goals?

Do you have any complaints related to communication not mentioned above? If so, do they come from you, or do they come from others?

Do you have any positive or negative personal experiences, learned behaviors, or beliefs that you feel might affect your breathing, your voice, your ability to be present, or your ability to communicate with others (in general or in specific situations)?

Do you have any concerns about working on communication with me?

Is there anything you'd like to add?

Payment & Cancellation Policy

Please check each box to confirm you've read and agreed to the following:

PAYMENT: I understand that payment is due before or just after our sessions, unless Saul and I have made a prior arrangement.

CANCELLATION POLICY: I understand that if I need to cancel an appointment, Saul asks for at least 24 hours advance notice. Otherwise, I will be charged for the session. (Exceptions for a true emergency, of course.)

HEALTH: I understand that if I have any symptoms of illness, for everyone's safety, we'll use Zoom.

Voice, Public Speaking, & Presence Coach Saul Kotzubei

Voice, Public Speaking, & Presence Coach Saul Kotzubei

Communication Questionnaire

Voice, Public Speaking, & Presence Coach Saul Kotzubei

COMMUNICATION QUESTIONNAIRE

Voice, Public Speaking, & Presence Coach Saul Kotzubei