First Meeting Form

Client profile
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
E-mail*
Information
Professionnel Occupation
How active are you at your work
Personal Information
Date of Birth*

MonthDayYear
Marital Status
Children?
As your coach it is important for me to understand your experience with sports, coaching and overall health.

These questions will hopefully provide a means for me to understand you and your

current position more closely and thus enable me to coach you to bring out your best.

Please take some time to answer these questions as thoughtfully and clearly as

possible. These questions are designed to be “mulled over” and to stimulate your

thinking on items that may in the past been automatic in the past.

My goal is to best coach you, understand you and empower you towards your goals and a better health.

If you have any queries please let me know and we can discuss them.
Have you been coached in any form or shape before? *
If you have, how regularly did it play a part in your life?
Please tell me about your experience. Was it helpful? If so, what difference did it make? Was it a positive or negative experience and why?
Please briefly elaborate on what you are wanting to archieve or overcome. *
If you could change some aspects of your physical/personnal situation what would you choose to change?
What do you consider to be your greatest health accomplishments so far?
What sports/ activity do you practice*
If you have any injuries, please list them
Goals
What are your top 5 health goals, either short or long term, at the moment?*
Challenges
What are your top 5 challenges at the moment?*
Coaching
What are your major objectives or gains that you wish to achieve from coaching?*
How would you want me to be as your coach?*
Please write any of your specific physical goals

Improve healthFat lossImprove enduranceIncreased muscle massIncrease strenghtImprove for one specific sportTo compete in a sportRecover from injuryGain weightIncrease powerReduce anxietyHelp fight a physical illnessImprove Self loveHelp with DepressionSpecial life event (ex: wedding)Other
Please write any of the major emotions you are wanting to overcome

FearAnxietyAngerRageHatredSelf HatredLonelinessDepressionSadnessHopelessnessRejectionUnforgivenessDoubtAbandonmentShameGuiltCondemnationEmotional PainOtherOther
I understand that this session is not a professional docrot and that Elizabeth Plante is not a licensed Kinesiolog, physio, chiro, psychotherapist, or medical doctor. I agree and understand I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the advice, opinions, or help that I might receive from Elizabeth Plante*
Yes/No
I understand that during these Life Consulting sessions I will be confronting my inner feelings and emotions, which could cause emotional pain and distress. I understand that if I receive Life Consulting from Elizabeth Plante that he is committed to respect the disclosed information, but not to complete confidentiality.*
Yes/No
Eli will take appropriate action and reporting if: 1. The client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm. 2. If a client threatens grave bodily harm or death to another person. 3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years. 4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses. 5. Suspected neglect of the parties named in items #3 and # 4. *
Yes/No
What else would you like to say?
By filling out my name I am electronically giving my signature to agree with the following: I have read this Liability Release and understand and agree with everything in it and have executed it as my free and voluntary act.*

Clear
Thank you!

Eli Plante
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Coaching session$75.00CAD

Coaching session

First test out call $ FreeCAD
This meeting is a 20 minute try out zoom meeting to connect and discussed future goals.

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Client profile

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Coaching