Client Intake Form

Name

First Name

Last Name

Phone

Country

(###)

###

####

Postal Address - For Billing Purposes

Date of Birth

Next Of Kin

Full Name | Relationship | Contact Number

What is your current occupation?

What are your expectations and desired outcomes from coaching?

What motivated you to seek coaching at this time?

Have you worked with a coach before? If yes, please share your experience.

What changes would you like to see in your life? What do you feel is hindering you the most from making those changes?

What previous steps have you already taken to achieve your goals? What has been the result so far, and what have you learned?

If you woke up tomorrow with the results you crave most, what would your life, career, relationships look like?

On a scale of 1 to 10, how would you rate your current happiness level? What makes you the most happy in your life currently?

On a scale of 1 to 10, how would you rate your current stress level? What is causing you stress?

How would you rate your overall well-being on a scale of 1 to 10? (1 being low and 10 being amazing)

How would you describe your current level of self-confidence and self-belief?

Are you committed to the coaching process and willing to put in the mental and emotional work required to get the results you desire?

HELL YES

Would you like to sign up to my newsletter for future tips, tools and resources?

Yes

Social Media Accounts - so we can continue to connect throughout your journey!

Is there anything else you would like to share about yourself or your circumstances that may be relevant to our coaching engagement?