Consultation Form
Thank you for your interest in coaching with me! This form helps me get to know you and your goals so we can create a personalized path for your growth and transformation. Please share honestly. Before submitting this form, please read the PRIVATE POLICY AND TERMS AND CONDITIONS PAGES. Disclaimer: I am not a licensed therapist or medical professional. My services are offered as coaching and intuitive support and are not a substitute for therapy, mental health treatment, or medical care. If you are experiencing significant emotional distress or need clinical support, please seek help from a licensed mental health professional.
Name
First Name
Last Name
Email
example@example.com
Session Focus
What is the main question, topic, or situation you want clarity on during this session?
*
What would a successful session look like for you today?
*
Communication Style
How do you prefer to receive guidance?
*
Direct, honest, and straightforward
Gentle, supportive, and nurturing
A balanced mix of both
How do you learn, understand, or integrate information best?
*
Real-life examples or relatable analogies
Journaling or reflection prompts
Intuitive or energetic language
How do you usually respond to feedback or new perspectives?
Tell me the truth exactly as you see it
Be mindful and validating first, then honest
I may be emotionally sensitive but I’m open
I appreciate honesty but need time to process
I’m not sure — it depends
Readiness Scale
Where would you say you are right now with this topic or goal?
1 — I feel stuck, confused, or unsure where to begin
2 — I have some awareness but not clear on next steps
3 — I understand the issue and need help forming a plan
4 — I have a direction and need refinement or confidence
5 — I’m clear and ready for execution — just need confirmation or strategy
By signing below, you acknowledge that this form has been completed accurately for the benefit of both the client (you) and the coach (Autumn), and serves as a record of your goals and consultation. You understand that coaching is intended to support personal development and goal achievement and is not therapy. The coach does not provide legal, medical, or financial advice. You further acknowledge that all decisions and actions related to these areas are solely your responsibility.
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