Client Intake Form

By completing this form, you will be able to identify your strengths, weaknesses, and areas for growth, which will help us work together to create a personalized coaching plan that is tailored to your unique goals and challenges. The questions cover a range of topics related to your personality traits, values, goals, and emotions, and are designed to be thought-provoking and insightful. I encourage you to take your time and answer each question honestly and to the best of your ability.
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Client Name
000-000-0000
Please note: This information will be kept confidential as with all other information shared with me per the confidentiality agreement below.
How do you typically handle stress or difficult situations?
How would you describe your self-talk and inner dialogue?
How do you typically handle feedback or constructive criticism?
How do you typically make decisions?
How do you handle interpersonal conflicts?
How do you typically handle your emotions?
How do you perceive your strengths and weaknesses?
How do you approach learning and personal growth?
How do you approach setting and achieving goals?
Are you currently experiencing any major life changing events? Please check any & all that apply
What self-help tools have you used in the past?
Please note: Under no circumstance will any information shared with me be disclosed to anyone without your approval. My clients' privacy and safety is of the outmost importance to me, therefore I will do my best to ensure it is never compromised. However, in the event you would like for me to disclose any information to anyone, whether a medical professional, therapist, counselor or another coach at your discretion, I will need your request in writing consenting to such disclosure including your full authorization and permission in writing as well. Thank you for your cooperation and understanding.