Mojo-Life Coaching - Client Intake Form
Name:
Email:
example@example.com
Phone Number:
Format: (000) 000-0000.
Personal Goals & Intentions
1. What is your main goal or intention for this coaching journey?
2. Why is achieving this important to you?
3. What feelings or outcomes do you want to experience by completing this program?
Current Situation & Challenges
4. Describe your current mindset and beliefs about your success, happiness, and yourself:
5. What are the main challenges or blocks you're experiencing right now, getting in the way of your goals?
6. Have you worked with a coach or done similar transformational work before? If yes, please describe:
Habits & Practices
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7. What daily practices or routines do you currently have? (e.g., meditation, journaling, affirmations)
8. What habits do you currently have that you would like to get rid of?
9. On a scale of 1-10, how committed are you to making changes and sticking to new practices?
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10
Expectations & Preferences
10. What do you hope to get out of this coaching experience?
11. Do you have any specific preferences or needs I should be aware of? (e.g., preferred session times, communication style)
Additional Information
12. Is there anything else you'd like me to know about you or your journey?
Signature:
Date:
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Date
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