MentorU! Coaching Client Intake Form

Personal Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Mailing Address*
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Occupation*
Company (if applicable)
Gender *
What is your race/ethnicity *
Do you need translation?*
If so, what language*
Emergency Contact
Full Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Coaching Goals
Please describe your specific goals for each selected area
Which coach are you interested in starting with?
Life Coaching*
Finance Coaching*
Business Coaching*
Purpose Coaching*
What are the biggest challenges you are currently facing in these areas?*
Have you worked with a coach before? If yes, please describe your experience*
How will you know that the coaching has been successful for you?*
Background Information
Describe your current life situation. Please include if you are married or single. If married, how long
Personal*
Professional*
Financial*
What is your long-term vision for your life, career, and financial well-being?*
What motivates you to seek coaching at this time?*
What are your strengths and areas for improvement?*
Are there any specific skills or knowledge you are looking to develop through coaching?*
Preferences
Preferred Coaching Format*

VirtualPhone
Best days/times for sessions:*
Any additional preferences or considerations:
Agreement
Responsibilities
- Coach Responsibilities:
  - To provide support, guidance, and accountability.
  - To listen and respond to the Client’s needs.
  - To maintain confidentiality.
- Client Responsibilities:
  - To actively participate in sessions.
  - To complete any assignments or tasks between sessions.
  - To communicate openly and honestly with the Coach.
  - To pay any additional fees after the initial Mentor U! Coaching sessions are completed, on time.
Cancellation and Rescheduling
- Clients must provide at least 24-hour notice to reschedule a session.
- Cancellations with less than 24 hours’ notice may result in the deduction of a session with the individual Coach the Client scheduled.
Termination
- Either party may terminate this agreement at any time with written notice.
Limitation of Liability
- The Coach makes no guarantees or warranties, express or implied, about the results of the coaching sessions.
- The Client agrees that the Coach is not liable for any actions or outcomes resulting from the coaching process.
Agreement and Acceptance

By checking the box below, I agree to the terms and conditions outlined in this agreement.
I agree to the terms and conditions outlined in the agreement
Should be Empty:

Personal Information

Emergency Contact

Coaching Goals

Background Information

Preferences

Agreement