Chopra Life Coach Session Intake Form

Chopra Life Coach Session Intake Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Emergency Contact Namae and Phone Number

General Information
What motivated you to seek life coaching?
Have you worked with a life coach or mentor before? If yes, please describe your experience.

Current Life Situation
How would you describe your overall well-being (physically, emotionally, and mentally)?
What are the biggest challenges you are currently facing?
What areas of your life would you like to improve? (e.g., health, relationships, career,personal development, spirituality, etc.)
What strengths do you believe you possess?

Health and Lifestyle
How would you rate your current health (1-10)?
Do you practice any wellness or mindfulness techniques (e.g., meditation, yoga, etc.)? If yes, please describe your routine.
Do you have any medical conditions or medications we should be aware of?

Goals and Vision
What specific goals would you like to achieve through life coaching?
Where do you see yourself in the next 6 months to 1 year?
What long-term changes would you like to make in your life?

Spiritual/Personal Growth
How would you describe your spiritual or inner life (if applicable)?
Are there any personal growth practices that you would like to explore (e.g.,mindfulness, emotional healing, etc.)?

Additional Information
Is there anything else you feel is important for me to know before we start oursessions?

Consent and Confidentiality
By signing below, I acknowledge that the information provided is accurate to the best of my knowledge, and I consent to engage in life coaching sessions with the
understanding that all shared information will remain confidential.
Date

MonthDayYear
Date
Signature

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