Life Coaching Client Form
Thank you for your interest in Life Coaching with The WELL Place of Healing & Transformation, LLC. This form is designed to help me learn more about you, your goals, and the areas in which you are seeking support. Please answer each question honestly and thoughtfully.
Personal Information
Full Name
First Name
Middle Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Email
Phone
Text
Age (Optional)
City & State
Coaching Interest
What inspired you to seek life coaching at this time?
*
Which area(s) of your life would you like to focus on?
*
Personal Growth
Purpose & Identity
Faith & Spiritual Growth
Self-Confidence
Emotional Wellness
Relationships
Life Transitions
Goal Setting & Accountability
Work-Life Balance
Stress Management
Other
Current Situation
Briefly describe your current situation
*
What challenges are you currently facing?
*
What would you like to change, improve, or achieve through coaching?
*
Goals & Vision
What are your top three goals for the next 6–12 months?
*
If coaching is successful, what would your life look like six months from now?
*
What strengths do you bring to this journey?
*
Coaching Readiness
Have you worked with a coach, mentor, or counselor before?
*
Yes
No
How committed are you to investing time and effort into your personal growth?
*
Very Committed
Somewhat Committed
Exploring My Options
What motivates you to make changes in your life right now?
*
Additional Information
How did you hear about The WELL Place of Healing & Transformation?
Is there anything else you would like me to know?
Client Acknowledgment
Acknowledgment
*
I understand that life coaching is a collaborative process designed to support personal growth, goal achievement, and transformation.
Acknowledgment
*
I understand that coaching is not therapy, counseling, or mental health treatment.
Acknowledgment
*
I agree to be contacted regarding my inquiry.
Signature
Client Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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