Zach Brunotte Coaching

Zach Brunotte Coaching

Client Intake Form
Demographics
Full Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Email
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Phone Number

Country CodeArea CodePhone Number
Location
City
State/Province/Region
Enter N/A if not applicable
Country
Why we ask: Coaching may be provided virtually across different states and countries, your location helps Zach Brunotte Coaching identify any location-specific considerations that may apply to services.
Coaching Interests & Goals
The purpose of this intake form is to help your coach understand a little about you, what brings you to coaching, and what you hope to gain from the experience. Please share as much or as little detail as you feel comfortable providing. You do not need to disclose anything you would prefer to discuss during a session instead. Your responses simply help us make the most of our time together and begin coaching with a better understanding of your goals and needs.
What type of coaching are you interested in? (Select all that apply)

Other
What brings you to coaching at this time?
Briefly describe the main concerns, goals, or areas you would like to work on.
What would you most like to gain from coaching?
What changes, progress, or outcomes would make coaching feel helpful to you?
Background & Current Supports

The following questions provide additional context that may be helpful to your coaching. Share only what you are comfortable sharing.
Are there any important life circumstances or recent changes that would be helpful for your coach to know?
For example: relationships, family, work or school, relocation, major decisions, or other significant life circumstances.
Are you currently working with a therapist, counselor, psychiatrist, or other mental health professional?
Is there anything about your mental or emotional well-being that you feel would be important for your coach to be aware of?
You do not need to provide diagnoses or private medical information. Please share only what you believe may be relevant to your coaching experience.
Faith, Values, & Coaching Preferences

Coaching can be tailored to your individual beliefs, values, and preferences. You are welcome to share as much or as little as you would like.
How would you describe your faith, religion, spirituality, or worldview, if any?
Optional — you may leave this blank if you prefer.
Would you like faith or spirituality incorporated into your coaching?
Is there anything you would like your coach to keep in mind about your values, beliefs, or preferred approach to coaching?
For example, topics you would particularly like incorporated, approaches you find helpful, or anything you would prefer not to incorporate.
- Partner's / Other Participant's Name
- How would you describe your relationship?
  For example: married, engaged, dating, separated, family relationship, or another type of relationship.
- How long have you been in this relationship?
- What would you most like to work on together?
  Briefly describe the main relationship concerns, areas for growth, or goals you hope to address through coaching.
- Will the other person be participating in coaching with you?
- Is there anything else you would like your coach to know before your first session?
  Share anything you feel may help your coach better understand you, your circumstances, or what you hope to gain from coaching.
- How did you hear about Zach Brunotte Coaching?
  
  Other
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Zach Brunotte Coaching

Demographics

Location

Coaching Interests & Goals

Background & Current Supports

Faith, Values, & Coaching Preferences