Client Intake Form Step 1 of 2 50% This questionnaire is designed for me to begin to learn what is important to you and what specific areas of your life you would like to work on, as well as for us to start getting a sense of the bigger vision you have for your life. It is also intended to help me understand how to best coach you. Your answers to this questionnaire are strictly confidential, so please respond openly. The more honest, thoughtful and complete you are with your answers, the better. However, please do not be concerned with spelling and grammar, and do not feel obligated to answer every question.Contact InformationYour Name(Required) First Last Preferred Pronouns Date of Birth(Required) MM slash DD slash YYYY Your Email Address(Required) Email Address Confirm Email Address Discord Username or ID I use this for sessions only if the client is familiar with it.Your PhoneAre you currently being treated for a mental illness, alcohol, or drug abuse? Yes No If yes, for what and how are you being treated? No need to go into super specific details; just general treatment receivedWhat are you hoping to get most out of our coaching relationship?(Required)Describe what led you to seek coaching and how you're hoping it'll help. Part II: Health historyJust some questions to help me understand the full picture!Please list your main health concerns:This could be mental, physical, or both!At what point in your life have you felt your best?Do you sleep well? Yes OK, but could be better Definitely not What role does exercise and/or sports play in your life?Any healers, helpers, or therapists with which you are involved? Please list:Do you have a solid support system?This could be a good group of friends, or a close friend, family, romantic partner, etcWhat is most important to you in your life and how do you know that?Anything else you'd like to share?CAPTCHA Δ
