Jeff Dorais · Men’s Coaching Form

Step 1 of 6 · About You

STEP 1 OF 6

About You

Full name *

Age (optional)

Email address *

Phone number (optional)

City / State / Country *

Time zone *

Occupation (optional)

How did you hear about this group? (optional)

Step 2 of 6 · Why Now?

STEP 2 OF 6

Why Now?

What has you interested in joining a men’s group right now? *

Where in your life do you feel stuck, disconnected, frustrated, or dissatisfied? *

If your life looked meaningfully different six months from now, what would have changed?

What do you hope to receive from this group?

What are you willing to bring to the group?

Step 3 of 6 · How You Show Up

STEP 3 OF 6

How You Show Up

What experience have you had with men’s work, coaching, therapy, personal-growth groups, meditation, breathwork, or somatic work?

If you’d like to say more about your answer

How comfortable are you talking about what you’re feeling—not just what you’re thinking? *

Tell me a little about your answer

What’s something about yourself you have a hard time letting other men see?

What do you want or need from other men but have difficulty asking for?

How do you respond when someone challenges you, disagrees with you, or gives you feedback you don’t want to hear?

What patterns in yourself are you beginning to recognize that you’d like to understand or change?

Step 4 of 6 · About the Group

STEP 4 OF 6

About the Group

Are you willing to keep what other men share confidential? *

Yes No I have questions about this

Are you willing to participate rather than simply observe? *

Yes No I’m not sure yet

Are you willing to attend consistently, arrive on time, minimize distractions, and have your camera on whenever reasonably possible? *

Yes No I need to discuss this

Are you willing to practice listening and curiosity instead of immediately giving advice or trying to fix another man? *

Yes No I’m interested in learning how

You always choose what you share. Participation does not mean disclosing something you aren’t ready to share.

Step 5 of 6 · The Right Container

STEP 5 OF 6

The Right Container

This is a men’s personal-development and coaching group. The work can sometimes be emotionally challenging.

This group is not psychotherapy, medical or mental-health treatment, crisis intervention, or a substitute for appropriate professional support.

Is anything happening in your life that could make emotionally challenging group work difficult for you? *

No Yes I’m not sure

If yes or unsure, tell me what would be useful to know

Are you currently working with a therapist, counselor, psychiatrist, coach, or another mental-health professional? *

No Yes Prefer not to say

If you’d like, tell me anything about that support that would be useful to know
Optional

Is there anything else about your circumstances you’d like me to know?
Optional

Step 6 of 6 · One Last Question

STEP 6 OF 6

One Last Question

Take a minute. Forget about sounding self-aware or giving the right answer.

If you stopped giving me the polished answer for a moment, what’s the real reason you want to be part of this group? *

What happens next

Submitting doesn’t commit you to joining or automatically mean you’re accepted. I’ll review what you’ve shared. If there may be a fit, we’ll arrange a short one-on-one conversation.

I’m looking for men willing to show up, get curious, tell the truth, and do the work.

I agree that Jeff may review this application and contact me about joining the group. *