Life Coaching Intake Form

First name

Last name

Phone

Birthday

Month

Day

Year

Emergency Contact Name

Emergency Contact Phone

1. What inspired you to seek coaching at this time?

2. What areas of your life are you hoping to transform or improve?

3. What are your top three goals you'd like to work on through coaching?

4. What are the biggest obstacles or patterns that have held you back?

5. How do you currently handle stress, challenges, or setbacks?

6. What support systems do you have in your life right now?

7. Have you worked with a coach, therapist, or healer before? If yes, how was your experience?

8. Is there anything about your health, mindset, or emotional well-being you'd like to share?

9. What would success look and feel like for you at the end of our work together?

10. Is there anything else you feel I should know in order to support you fully?

Signature

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