Client Intake Form

Name

First NameLast Name

Gender

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Occupation

Have you ever had a professional coach (life, transition, career, ect)?

If yes, please indicate the style of coaching below:

How would you like to conduct your coaching session?

How often would you like to have a coaching session

What are the things that makes you happy?

What are the things that upset you?

What changes would you like to make in your life right now?

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.

How did you find out about our services?

Would you like to receive product updates, news, and promos?