Client Intake Form

The next chapter of your journey begins! please take a moment to complete this short questionnaire. This will help you self-reflect at the beginning of the coaching journey. It will also help me understand your life, goals, and challenges so that I can best support you.

Name

First Name

Last Name

Phone

(###)

###

####

What are the main reasons you are interested in coaching right now?

What are 3-5 skills you currently have and are proud of?

What's missing currently from your life that you desire?

Where do you want to be 3-6 months from now? What goals or milestones (size doesn’t matter!) would you feel grateful and excited to have achieved?

What are some skills you’d like to develop or enhance in yourself (in the next few months)?

What do you think holds you back the most currently?

You can type N/A if you're unsure how to answer.

Please describe a typical day in your current life. What are your daily habits and routines? Are there certain daily habits or routines that you envision in your next chapter “dream life”?

Describe a typical day in your life. What are your daily habits and routines?

Is there anything you want to share about how you make changes that will help me most in coaching you?

Are you currently in therapy? Please share any information that you think will be helpful in our coaching relationship.

Do you have any questions you want to make sure I answer?

What are some of your favorite books, movies, shows, and/or characters?

Please select up to two complimentary workshops for any specific areas of focus. This is complimentary with your coaching program.

We can work through these together 1:1 (completely optional!)

When's your birthday?

Client intake form

Why I Built Dream Brand Launch

A Few Quick Facts About Me: