Client Intake Form Please complete the form below Name * First Name Last Name Email * You’re here for a reason. Start by listing out some initial intentions or goals. These aren’t set in stone but they'll help to frame the journey on which you’re about to embark. Six months from now, what do you hope is different? What are you aiming for? Three years from now, where do you want to be and what will be different? Why coaching and why now? What would you like to change? Where would you like to grow and expand? What three accomplishments in your life are you most proud of? This can be professional or personal. When do you feel most committed, connected and alive? What are you doing? Who are you with? What’s the biggest thing you’ve overcome or moved through? When was it the darkest or most difficult and how did you find the light and come back from that? What do you value most about yourself? Where do you excel and shine? Over the last few years, think about all the changes that have happened in your life; at work and at home, with friends and family. What have you lost? What have you gained? Has it been a little or a lot? How are these changes sitting with you? What brings you joy? What gives you a sense of purpose and passion? On a scale of 1 – 10 (10 being HIGH, 1 being LOW) provide a number that best represents your current level of stress: What's stressing you out right now? On a scale of 1 – 10 (10 being HIGH, 1 being LOW) rate the quality of your life today: Your values are beliefs you hold about what's most important to you. Values can be a personal measuring stick that help you make important decisions. What are your top five values? As we begin our coaching relationship, how will you know if we’ve been successful? What will be different? Thank you!
