Life Coaching Client Intake Form

Please fill out and submit the following form at least 24 hours prior to our session.

Below is a guided meditation that may help you find clarity and release judgement around these questions and your answers. Find a quiet space and enjoy the meditation prior to filling out your form.

Clearing Meditation

Client Information

First name

Last name

Phone

Date of Birth

Month

Day

Year

Time of Birth

Time

HoursMinutes

Location of Birth

Client Goals, History and Expectations

Please help me get to know you and the obstacles you face so I can best be prepared for our session, by answering the following questions:

What do you wish to gain from this session?

Do you feel seen and heard? Please explain why you feel this way.

What is your process of moving past and overcoming obstacles?

How will you know when you have reached your goal and intent for this session?

If there was something you were avoiding or running away from, what would it be?

If you have limiting self-beliefs, what would they be?

If you had strengths and weaknesses, what would they be?

What do you enjoy doing in your free time?

Do you exercise or have physical or mental practices that you do daily? Please list below.

What do you want me to know about you?

Disclaimer

I understand that mentoring/coaching is not therapy or a medical treatment and that it is not a replacement or subsitute for professional advice by legal, mental, medical or any other qualfied professionals. I understand that coaching/mentoring will not be diagnosing or treating any medical or psychological condition. This form is an agreement for services that lays out the coaching package I have agreed upon, with the time frame and amounts for payment and what coaching services will be provided in return. is a self-awareness transformative life coaching program that inspires and supports clients through self-empowerment, realizing their potential through personal achievement, and improving the quality of their life through service to others.

I confirm my knowledge and consent to the above disclaimer.