Client Intake Form

Client Intake Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of BIrth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo
If yes, please describe.
Briefly describe what brought you to coaching.*
What would you most like to gain from this process?*
What are your top three goals for this program?*
What challenges or patterns would you like to address?*
How would you describe your faith or spiritual journey?*
Preferred days and times for sessions.
In PersonZoom/Virtual
Friend/FamilySocial MediaWord oof MouthOther

Arno Profile System (APS)
The Arno Profile System (APS) is a Christian-based assessment created by Drs. Richard and Phyllis Arno to help people better understand their God-given temperament. Simply put, it looks at how you’re naturally wired, your strengths, challenges, and the way you relate to the world around you.

APS helps bring clarity to the parts of yourself that feel instinctive or “just who I am,” separating your natural temperament from learned behaviors or life experiences.

People who use the APS often walk away with greater self-awareness, healthier relationships, more self-acceptance, and better tools for managing stress and emotions. Most importantly, it encourages personal and spiritual growth by helping individuals live more in alignment with how God uniquely created them.

The system is rooted in biblical principles, especially Psalm 139, which reminds us that God formed our “inmost being” with intention and care.
I have read the details of the required Arno Profile Systems assessment and understand that the completion of the assessment is a mandatory part of the coaching process.
Professional Disclosure Statement
InLight Coaching Services helps individuals and families gain insight into their internal wiring, offering clarity about themselves and a deeper understanding of the people around them. Our coaches are Certified Christian Counselors and Creation Therapy Coaches with experience working with clients in the area of personal growth. Please note that InLight Coaching Services and its coaches are not licensed therapists, psychologists, or mental health professionals. The services provided are coaching and counseling from a faith-based perspective, focused on personal development, relationship enhancement, and spiritual growth. These services are not intended to diagnose or treat any mental health condition. If at any time it appears that additional or alternative professional support may be beneficial, we may provide a referral to a licensed mental health provider or other qualified professional. By proceeding with coaching services, you acknowledge that you understand the nature and scope of these services and agree to participate within this framework.*

I, the undersigned client, understand the qualifications of the providers and agree to continue coaching services with these professionals.
Confidentiality Agreement
At InLight Coaching Services, your privacy is of utmost importance to us. All personal information, discussions, and assessment results shared during your sessions are kept strictly confidential. Information will not be shared with any third party without your written consent, except in cases required by law (such as risk of harm to self or others). Our goal is to create a safe, judgment-free environment space where you can speak openly and honestly.*

I, the undersigned client, have read and understand the confidentiality agreement.
Cancellation Policy
I, the undersigned client, have read, understand, and agree with the cancellation policy.
Client's Right
Some clients need only a few sessions to achieve their goals while others require months or sometimes years of services. You are in complete control and may end the coaching relationship at any time, though your provider may invite you to participate in a termination session once this decision has been made. You also have the right to refuse or to discuss modification of any of coaching techniques or suggestions that you believe might be harmful. Your provider has the right to determine if they can accommodate the request to adjust the approach depending on the limits of their scope of practice and/or their coaching boundaries.*

I, the undersigned client, understand my rights in the process and that I have the right to choose to continue or discontinue at any time.
Payment Policy & Fee Schedule
I, the undersigned client, have read and understand the Payment Policy & Fee Schedule and agree to pay according to the terms outlined above or to a pre-arranged and agreed upon rate indicated previously in the consent form.
Consent to Participate in Coaching Services
By signing below, you acknowledge that you have voluntarily chosen to participate in coaching services provided by InLight Coaching Services. You understand that coaching is not a substitute for medical, psychological, or psychiatric treatment and that your participation is focused on personal growth, relationship development, and faith-based guidance. You agree to take full responsibility for your own decisions, actions, and results during and after the coaching process.*

I, the undersigned client, have read the consent to participate in coaching services and agree to the services outlined.I, the undersigned client, understand that I may withdraw consent for services I receive through InLight Coaching Services at anytime.
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Client Intake Form

Arno Profile System (APS)

Professional Disclosure Statement

Confidentiality Agreement

Cancellation Policy

Client's Right

Payment Policy & Fee Schedule

Consent to Participate in Coaching Services