Life Coach Intake Form
(All coaching sessions are held virtually via Zoom)
❤️Let the help starts here❤️
Name ( First name Last Name )
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First Name
Last Name
Age
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Gender
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Male
Female
Prefer not to say
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address:
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City, State
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Country
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Are you currently taking any medications?
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Do you have any health condition that you would like to share?
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What are your professional goals ( or life goals)?
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What changes would you like to make in your life right now?
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What are the things that upset you?
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What are the things that makes you happy?
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What is your motivation in life?
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What are you willing to do to achieve your goals?
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What are your strengths and assets?
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What are your weaknesses?
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What are your expectations from this coaching relationship?
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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 life coach and the client.
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Yes, I understand
Submit
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