New Client Intake Form

Personal Information

First name

Last name

Phone

Address

Birthday

Month

Day

Year

Occupation

How did you hear about me?

Goals

What areas of your life would you most like to focus on in coaching (for example: mindset, relationships, leadership, or personal growth)?

If life looked different a year from now in the best possible way, what would that look like for you?

Insights into You

What do you value most in your life right now?

What core values guide your decision making?

Where do you turn for support and encouragement in your life?

How do you define being the best version of yourself?

Coaching

What prompted you to seek coaching at this time?

What would make the coaching experience feel most valuable to you?

Have you worked with a coach previously? If yes, what was your experience like?

When you think about working with me, what kind of support do you imagine will help you most? (e.g., accountability, encouragement, challenge, practical tools, deep reflection)

Other

Please list any available assessments that you have taken within the last 18 months

What else might be important to share as we work together?