• Client Intake Form

    Queer Spectrum Life Coaching, LLC
  • If you have not done so already, please sign the 'Confidentiality and Liability Agreement' located on the client page on www.queerspectrumlifecoaching.com before filling out this intake form. This 'Client Intake Form' consists of general intake information, attesting you signed the Confidentiality and Liability Agreement, emergency contacts, general health information (not personal health information), and coaching questions. This form is to be filled out prior to your free 30 minute consultation to help prepare the coach and to make sure you get the most out of your time. Filling out this form does not indicate an obligation to services by the coach or yourself. Again, you are NOT commiting to services by signing this contract. If you and the coach decide to work together, then you will fill out the 'Coaching and Client Agreement' which is a commitment to services.

  • General Intake Information

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  • Attestation to Reading and Signing the 'Confidentiality and Liability Agreement'

  • Emergency Contacts

  • General Health Information

  • Queer Spectrum Life Coaching, LLC, asks for the following health information to ensure that you responsible for your medical and health needs. By answering these questions you are affirming that you are not seeking life coaching for medical or theraputic services and you have those services and resources in place elsewhere. Queer Spectrum Life Coaching, LLC, is HIPAA compliant.

  • Coaching Questions

  • I am asking the following questions in order to better get to know you so we can get started sooner in our relationship rather than later. The more I know about your life, wants, needs, roles, and personality, the better I can help find ways to support you effectivly. Answers to these questions can be as sparse or detailed as you would like. Share what you find necessary and what you are comfortable with sharing. You may skip questions that don't feel applicable or that you are uncomfortable answering at this time. 

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