Transition Intake Form

Thank you so much for your interest in working with Simple Solutions Consulting! Please fill out the form below and someone will connect with you within 48 hours to schedule a consultation. For any additional questions, please feel free to send an email to info@mysimplesolutionsconsulting.com.
Client Name

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred Contact Method
Best Days/Times to Contact You
Transition Background
Current Transition Type

Other
Other Transition Type
Description of Current Transition
Reason for Seeking Transition Consulting Now
Current Biggest Challenges
Support Needs and Growth Areas
Areas You Need the Most Support With

Other
Other Support Need
Personal Growth Areas

Other
Other Personal Growth Area
Detailed Support Categories
Areas Where Support May Be Needed – Personal & Daily Living

Other
Areas Where Support May Be Needed – Family & Household

Other
Areas Where Support May Be Needed – Career & Education

Other
Areas Where Support May Be Needed – Relocation & Stability

Other
Areas Where Support May Be Needed – Personal Development

Other
Areas Where Support May Be Needed – Emotional & Transitional Support

Other
Other Needs
Current Support System

Other
Other Support System
What You Hope to Gain From Working With a Consultant
Additional Information About Circumstances, Goals, Challenges, or Support Sought
Client Acknowledgment
Client Acknowledgement

I understand that transition consulting is intended to provide guidance, planning, organization, resource navigation, personal development support, and practical assistance during periods of change.
I understand that consulting services are not a substitute for medical, mental health, legal, financial, or other licensed professional services when those services are required. When appropriate, my consultant may recommend that I connect with qualified professionals or community resources.
I understand that completing this intake form does not guarantee a specific service or outcome. Services will be discussed and agreed upon based on my identified needs.
Client Signature
Client Acknowledgment Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Thank you so much for your interest in working with Simple Solutions Consulting! Please fill out the form below and someone will connect with you within 48 hours to schedule a consultation. For any additional questions, please feel free to send an email to info@mysimplesolutionsconsulting.com.

Transition Background

Support Needs and Growth Areas

Detailed Support Categories

Client Acknowledgment