Autism Coaching Intake Checklist
Use this form to share coaching goals, communication preferences, sensory needs, availability, and other details that help prepare for autism coaching sessions.
Intake Information
Client or Caregiver Name
*
Preferred Contact Email or Phone
*
Preferred Coaching Session Format
*
In-person
Video call
Phone
Autism Coaching Needs and Goals
What are the main goals you would like to work on through autism coaching?
*
What current challenges or support needs would you like coaching to focus on?
*
Top 3 coaching priorities
*
Communication, Sensory, and Scheduling Preferences
Preferred communication methods
*
Email
Text message
Phone call
Caregiver contact
Sensory or environmental preferences for sessions
Quiet room
Low lighting
Minimal background noise
Camera off when possible
Breaks as needed
Use visuals or written notes
Other
Preferred days, times, and accessibility considerations
Background and Support Context
Age range / life stage
*
Child
Teen
Young adult
Adult
Older adult
Prefer not to say
Other
How did you hear about this coaching?
*
Self-referred
Referred by family
Referred by friend
Referred by professional
School or workplace referral
Other
Additional notes for the coach
Submit
Should be Empty: