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