New Client Intake Form- Ramala, the Life Coach

New Client Intake Form by Ramala, the Life Coach L.L.C.

Full Name*

Date of Birth*

Date

Preferred Pronouns*

Contact Information*

Name*

Relationship*

Phone*

Coaching Goals and Vision What are your top 3 goals for life coaching?

What are your top 3 goals for life coaching?*

Describe the life you desire for yourself in 3-12 sentences?*

What do you feel is holding you back from achieving your goals?*

Rate the following areas of your life on a scale of 1-10

(1 = Needs Improvement, 10 = Thriving):

Relationships Family Friends Partner*

Mental Health*

Self Esteem*

Financial Stability*

Trauma Informed Questions*

Have you experienced significant challenges, loss, or trauma in your life?

Optional response only answer what you feel comfortable sharing.

Are there specific fears habits or patterns youd like to address?*

What does a typical day look like for you?*

What habits or routines currently support your wellbeing?*

Are there habits you'd like to add improve or eliminate?*

What are your greatest strengths?*

What values are most important to you in your life?*

Relationships How would you describe your relationships with family, friends, and/or your partner?

How would you describe your relationships with family friends and or your partner?*

Are there specific relationship challenges you'd like to address?*

Are you satisfied with your current career or educational path?*

If not what kind of work or purpose would feel fulfilling to you?*

How do you currently take care of your physical and emotional health?*

How do you cope with stress or difficult emotions?*

Are there selfcare practices youd like to incorporate?*

On a scale of 1 1-10, - how committed are you to making changes in your life?

What motivates you to create change?*

Is there anything else youd like me to know about your life or goals?*

What would make you feel supported during our coaching sessions?*

Are you currently working with a therapist or counselor? Yes / No*