Intake Form

Client Intake
Name*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Birth Date

MonthDayYear
Date
Current Occupation
Current Life Situation: Include areas of satisfaction & dissatisfaction.
Goals & Aspirations
Challenges & Obstacles
Health & Wellness
Emotional & Psychological Well-Being*
Support System
Coaching History: History of prior coaching.*
Expectations: What do you expect to get from this coaching engagement?*
Availability & Scheduling Preferences
Other Relevant Information
Preferred Initial Appointment Date & Time
Your Time Zone
Preferred Meeting Approach*
If you prefer online meeting which service do you prefer?
Which Service(s) are you interested in?*

General CoachingLife Vision & Strategy DevelopmentDetailed Action PlanningProgress Check-InLife Vision & Strategy RenewalOther
SetFire Coaching Agreement
SetFire Terms of Service & Privacy Policy
I have read and agree to the following:*

SetFire Terms of Service & Privacy PolicySetFire Coaching Agreement
Signature*

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Client Intake