Client Form

Please complete the following form 48 hours before our first session.

This questionnaire is completely confidential, and the information you provide will only be used to help me support you better.

Name

First Name

Last Name

Phone

(###)

###

####

Date

YYYY

Life Presently... where are you now? Please describe the challenge you're currently facing.

What bothers you most about this challenge?

What have you already tried?

Your Exciting Future... 1-3 years from now. If we could wave a magic wand, where would you like to be three years from now?

And one year from now?

At this point, what do you feel is holding you back from moving forward?

What emotions, issues or pain would you like to address during your session?

On a scale of 1 to 10, how intense do you feel these emotions or challenges right now?

What is most important to you about this next phase of your life?

Getting Started... your session. What would you like to focus on in your session?

As a result of your session with me, what is your main desired outcome?

What are your expectations from me as your coach?

Is there anything else important that you would like to mention before our session

I agree to the Terms & Conditions

Yes