Holistic Coaching Intake Form
Please be as detailed and honest as possible.
Email address *
First and Last Name: *
Physical address:
Best number to contact you: *
Email address: *
Emergency contact name and number: *
Who do I thank for the referral?
What type of work do you do?
Why did you decide to seek holistic coaching?
Have you had coaching or counseling before? How was it?
How would you describe your spiritual connection or practice? *
If you had a magic wand and could make your life just how you want it, what would it be like? *
What do you think stops you?
What are your best attributes?
What do you want to change or improve about yourself?
Are you working with any other provider? What for? Who?
Please describe a typical week in your life (honestly)
What are you most proud of?
What are you grateful for?
Thank you for filling out this form. The information you provided will help us work optimally.
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