Life Coach Intake Form

Life Coach Intake Form
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status

SingleMarriedDivorcedWidowed
Occupation
Please specify below if you're interested in Group Coaching, Fast Track Coaching or Both

Group CoachingFast Track CoachingBoth
What are your personal and professional goals?
What changes would you like to make in your life right now?
What are the things that upset you?
What are the things that makes you happy?
What is your motivation in life?
What are you willing to do to achieve your goals?
What are your professional strengths and assets?
What are your expectations from this coaching relationship?
AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of coaching the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client.

*Please note that this is a Christian faith based business.
$25 will secure your space for a 30 minute discovery call via zoom. Request for payment will be sent after your form has been reviewed. Please specify your method of payment choice below. After payment has been received, a link will be sent for you to schedule a time on my calendar.
How did you find out about my coaching services?

Social MediaYouTube VideoSearch EngineAdsOther
Would you like to be added to our email list?

YesNo
Should be Empty: