Client%20Intake%20Form%20Master%20Coaches%20Academy

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What are the three biggest CHALLENGES you currently have in your life?

1

2

3

What do you wish was different in your life

What are 3 inspiring goals that you would like to accomplish in the next 12 months?

1

2

3

What major transitions have you had in the past two years Example Entering or approaching a different age a new or different relationship job role residence A change in childrens agesstages etc

Please list anything new you are committed to over the next 12 months in the following areas

Familyhome life

Financial situation

Career or business life

Personal character

Relationships

Leisure time

Selfcare

Learning

Other areas

Who are the key people in your life and what do they provide for you

On a scale of 1 to 10 10 high rate the amount of stress in your life right now

What are your primary stressors

List the 5 words that describe you at your best

What motivates you

What takes away your motivation

On a scale of 1 to 10 with 10 being high rate the quality of your life today

If you reach the age of 95 and continue to live your life and order your time the way you are right now what regrets do you think you will have Tip complete the statement I wish I had Do not include things from the pastonly things you will regret if you continue your exact present path

Application Form

GOALS