COACHING INTAKE FORM

Before your appointment with Dr. Scott Massey, please fill out the form below to provide some background info and insight into what you are looking for with one-on-one coaching.

I am interested in one-on-one coaching regarding (choose all that apply):
I have specific goals I want to achieve:
I practice daily affirmations
I am satisfied with my current profession
I would like to:
I have been drinking for:
I have been sober for:
I have had chronic pain for:

Thank you!