Intake From
Kristal Schwartz
kschwartz15@gmail.com
Coaching with Courage_findher
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Email *
Name: First and Last Name *
Age *
Birthday *
MM
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DD
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YYYY
Phone Number *
City and State *
Marital Status   *
Occupation *
Are seeing a psychiatrist or licensed therapist   *
Are you taking any medication for mental health *
If yes, then please indicate the medication name and the purpose below: *
Do you have any health condition that you would like to share? *
What are your personal goals? *
What are your professional goals? *
What changes would you like to make in your life right now? *
What are the things that upset you? *
What are the things that makes you happy? *
What is your motivation in life?
What are your professional strengths and assets? *
What are your expectations from this coaching relationship? *
AGREEMENT/REMINDERS: I understand that all information I entered in this form will be considered strictly confidential. The data gathered from this form will only be used as a basis for the type of coaching the client will need.I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client.
Are you getting out of a High Conflict Relationship or Divorce? *
PLEASE GIVE ME A BRIEF SYNOPSIS OF WHAT THE CURRENT ISSUES ARE IN YOUR DIVORCE OR CUSTODY BATTLE:
If Yes, DO YOU HAVE AN UPCOMING COURT DATE TO DISCUSS? WHAT ARE YOU CURRENTLY STRUGGLING WITH?
TELL ME THE FIVE THINGS THAT ARE WEIGHING MOST HEAVILY ON YOUR MIND:
Signature:
Coaching Packages - 50 min sessions
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