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Initial Coaching Intake Form
Help us understand your goals, current situation, and expectations to tailor your coaching journey effectively.
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Email
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Full Name
Your answer
Email Address
Your answer
Phone Number
Your answer
What is the primary area you are seeking coaching support in?
Career & Professional Development
Personal Growth & Self-Improvement
Relationships & Communication
Health & Well-being (e.g., stress, work-life balance)
Financial Abundance & Management
Other (Please specify below)
Clear selection
If 'Other' was selected above, please specify your primary coaching focus.
Your answer
Please describe your desired outcome or goal for this coaching engagement.
Your answer
On a scale of 1 to 10, how motivated are you to make a significant change in your life right now?
Not at all motivated
1
2
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9
10
Extremely motivated
Clear selection
What major obstacles or challenges are currently preventing you from achieving your goal?
Lack of clarity/direction
Time management/Procrastination
Fear of failure/Self-doubt
External circumstances (e.g., job, family demands)
Lack of accountability
Other mindset blocks
None of the above/I'm unsure
Which days of the week are you generally available for coaching sessions?
Morning (9am - 12pm)
Afternoon (12pm - 4pm)
Evening (4pm - 7pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Morning (9am - 12pm)
Afternoon (12pm - 4pm)
Evening (4pm - 7pm)
Monday
Tuesday
Wednesday
Thursday
Friday
How would you prefer to conduct your coaching sessions?
Video Call (e.g., Zoom, Google Meet)
Phone Call
In-person (If locally available)
Mixed (e.g., Some phone, some video)
Clear selection
How did you hear about our coaching services?
Choose
Referral from a friend/colleague
Social Media (Instagram, LinkedIn, etc.)
Website/Blog
Search Engine (Google, Bing, etc.)
Networking Event
Other
How would you rate your current level of satisfaction with your life overall?
1
2
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5
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7
Clear selection
Is there any other information you believe would be helpful for your coach to know before your first session?
Your answer
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