Client Intake Form Personal InformationFirst NameLast NameDate of BirthEmail AddressPreferred PronounsPreferred video conferencing softwareGoogle MeetDiscordDiscord Username or IDI use this for sessions only if the client is familiar with it.Treatment InformationAre you currently being treated for a mental illness, alcohol, or drug abuse?YesNoIf yes, for what and how are you being treated?What are you hoping to get most out of our coaching relationship? *Please list any of your primary health concernsThis could be mental, physical, or both.At what point in your life have you felt your best?Do you sleep well?YesOK, but could be betterNopeWhat role does exercise and/or sports play in your life?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?Submit my informationSave as DraftLeave this field emptyPlease do not fill in this field.
