Amechi G’s Coaching Intake Form

Amechi G’s Coaching Intake Form
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Country City and State

Country

City

City State/Province

Country
Marital Status
Occupation
Do you have any health condition that you would like to share?
If yes, then please share them below:
Do you have a relationship with God, The Most High?
If so, describe your relationship. What does it look like?
Do you own a Holy Bible that you have a connection with?
On a scale of 1-10, how committed are you to changing the way you think?

1

2

3

4

5

6

7

8

9

10

1 is Least , 10 is Most
On a scale of 1-10, how discipline are you?

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2

3

4

5

6

7

8

9

10

1 is Least , 10 is Greatest
What is a Definite Chief Aim or goal you would like to accomplish?
Do you have an idea of your purpose?
If so, what is your idea of it?
What are some of your expectations for our new coaching relationship?
On a scale from 1-10, how much do you like reading books?

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2

3

4

5

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10

1 is I do not read, 10 is I love reading
Schedule Your Free Introductory Session
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 coach and the client.
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