Please select the pre-coaching form if you have a coaching session with Naima. If you have a therapy session, please select the pre-therapy session form below.Please aim to complete it at least 24 hours before to get the most out of your session Pre-coaching form Open Form Pre-coaching form Name * First Name Last Name Email * Date of our session MM DD YYYY Specific, measurable actions/next steps I committed to on our last call. (Be sure you address each commitment made, whether acted on or not and no matter to what degree)? * Actions I have taken since our last call: * What went well and what I am celebrating: * Challenges I have experienced and/or lessons I have learned since our last call: * What am I grateful for and/or what I want to acknowledge myself for this week: * Were you out of your comfort zone? * What morning routines and have you committed to this month (how many time out of 7 did you act upon each action) * What evening routines and have you committed to this month (how many time out of 7 did you act upon each action) * Outcomes for our next call. What do you need from this call to move you forward on your goals? * How many times have you listened to the audio this week? * Taking stock of barakah activities * Quran per day 7 salwaat per day Istiqfaar per day What are you enjoying about your therapy and coaching right now? * Thank you for submitting your answers. - Team Naima Mohamed Pre-therapy form Open Form Pre-therapy form Name * First Name Last Name Email * How does the issue that you want to address in this session show up in your life negatively? * What are the triggers that bring it to the surface (specific people, situations, thoughts, social media etc). * When it comes to this issue, what things do you judge, criticise yourself on or feel guilt and shame around? * What would life look and feel like without this issue? * If you could go back in time and say the things the "little you" needed to hear, what would you say to your younger self? * Please confirm here that you do NOT have seizures, any form of epilepsy, a pacemaker, heart conditions and are NOT taking anti-psychotic drugs. * From the list below check as many areas that concern you: Check all that are applicable to you. Limiting beliefs Money blocks Visibility fears Self-sabotage Fear of rejection Fear of abandonment Fear of failure Fear of judgement People pleasing/overgiving Mother wounds Father wounds Confidence issues Clinical Depression Historical Depression Childhood trauma/abuse Bullying Domestic abuse Feeling unsafe Thank you for submitting. Let’s remove baggage from the past and rewire your brain to support your healing and goals. Love, Naima x
