Client Intake
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Birthday
-
Month
-
Day
Year
Date
Occupation
What do you most hope to accomplish with our coaching sessions?
Describe what made you decide to pursue Christian coaching?
What do you imagine will happen if you make progress toward your goals?
Who in your life is most supportive of your goals?
Is there anyone whose opinion makes you feel scared, embarrassed, or unsure of pursuing your goals?
What forms of Christian practice are comfortable for you within our coaching sessions:
Prayer
Reading Scripture
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you able to commit to homework exercises outside of sessions?
Yes
No
Are you willing to journal and take assessments?
Yes
No
Do you find that you act quickly once you have chosen a course of action, or do you take additional time to process/contemplate?
What has helped you reach your goals in the past?
What do you consider to be your greatest strengths? How will these relate to reaching your goals?
What would you like to change about yourself? How will this relate to reaching your goals?
Do you have other goals you have not mentioned because they are intimidating or feel too big to say out loud?
Of the goals discussed, which do you feel is most important for us to begin?
What would you like me to know about you that we have not already covered in this form?
Signature
Should be Empty: