General Intake Form
CONGRATS! You have come to the right place for support on your journey! Of course, you can do everything on your own, after all, my tagline is BE YOUR OWN HERO! Hiring a coach for a single session or a package of sessions is extremely useful to identify blocks (and hold you accountable) to get you living your best life as quickly as possible!

Before we jump on a call, please answer the questions below. This will ensure we maximise our time together and also indicate if we would be a good match for a multi-week coaching/client programme.

During our session, we will discuss a general roadmap towards success. By the end of the session, we will both have an opportunity to decide if working together would be the right decision.

My objective is to fully understand your needs so we can focus our time on helping you transform your mind & body in a safe and effective way.

*Please take comfort knowing all information will be kept confidential.
Email address *
1. Name (First and Last) *
Your answer
2. Framing: For me, hiring a coach is so I can learn a specific skill as fast as possible. What does it hiring a coach mean for you? *
Your answer
3. What area(s) of your life are you struggling? *
Required
4. What have you done in the past to encourage personal development? (include both traditional & non-traditional approaches) *
Your answer
5. What has proven effective? *
Your answer
6. Tell me about your eating habits. Please be specific. List breakfast, lunch, dinner, snacks as well as the times you eat and most importantly what you eat. *
Your answer
7. Are you taking any medications/supplements? If yes, please list what you take and the intended purpose. *
Your answer
8. When something does not go according to plan, how do you cope? (avoid/distract or confront the problem. Please offer a specific example and your go-to emotion) *
Your answer
9. Have you worked with a coach before? *
10. What was the last thing you celebrated? *
Your answer
11. What does a typical Saturday look like for you? (meaning how do you spend your free time) *
Your answer
12. What do you hope to get out of our time together? *
Your answer
13. How would you feel once you achieve this result? *
Your answer
14. What are 5 things you LOVE about your life at this exact moment? *
Your answer
15. How did you find me? *
Required
A copy of your responses will be emailed to the address you provided.
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