Get Started: Intake Form

Shyft Inspired Intake Form

Come get inspired as you transform
Preferred Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Phone Number
Email
example@example.com
Address/ Optional

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status

SingleIn a relationshipMarriedDivorcedWidowed
Education Level

Grade levelHigh school deplomaBachelor's degreeDoctoral degree degree
Review the following questions and answer honestly.

Remember, your success depends on the extent to which you are honest and open to the experience.
Occupation
Do you have any health condition that you would like to share?

YesNo
If yes, please explain:
What are your personal goals?
What are your professional goals?
What changes would you like to make in your life right now?
What are the things that upset you?
What have you tried before to address this issue?
What are the things that make you happy?
What is your motivation in life?
What changes would you like to make in your life right now?
What are your expectations from this coaching relationship?
Which life coaching area(s) are you seeking the most support in?

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

YesNo
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Shyft Inspired Intake Form

Review the following questions and answer honestly.

Accredited & Certified by the