Coaching Intake Form
Please spend a few minutes reflecting upon the below questions.
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1.
Full name, Age
(Required.)
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2.
Email address
(Required.)
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3.
Marital status (never married, married, separated, divorced, widowed)
(Required.)
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4.
What is your profession?
(Required.)
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5.
Do you enjoy your work? Why or why not?
(Required.)
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6.
What other modalities or practices have you interacted with to help you reach your goals?
If you have undergone therapeutic treatment for any of the following: bi-polar/manic depression; post-traumatic stress; clinical depression; eating disorders; and/or suicide attempts, bring this up on our discovery call so we can determine together if coaching is a good fit for you at this time.
(Required.)
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7.
What are three things you most want from our time together? What are three things that you want to move through/ release/ transform in our time together?
(Required.)
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8.
What are the biggest challenges in your life right now?
(Required.)
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9.
Do you have an intimate relationship (husband, wife, life partner, boyfriend, girlfriend, etc.)? If so, what is the quality of that relationship? What is great about it? What needs work?
(Required.)
10.
Are you ready to invest in coaching?
Yes
No