STL Client Intake Form

Spring to Life Coaching Client Form
Date:*
MonthDayYear
Date
Name:*
Occupation:*
Age:*
Home Address:*
Cell Phone:*
Email Address:*
Preferred Method of Communication*
text, email, or call
Okay to send texts &/or leave messages everywhere? If not, explain:*
Emergency Contact (Include Full Name & Telephone Number)*
Preferred Coaching Schedule (day of week; time of day)*
How did you hear about my coaching services?*
Have you ever had coaching before? If so, how was the experience?
What influenced your decision to work with a coach now?*
What do you hope to gain from coaching?*
Have you ever been diagnosed with a mental health condition? If so, what?*
Are you currently seeing a therapist or counselor?*
Is your faith a source of support that you would like to use in coaching?*
Name 3 goals to accomplish in next 3 months:
Where do you want to focus first in your coaching?*
What would make this coaching a success for you?*
Other information you may want me to know:
Should be Empty: