Client Intake Questionnaire

No need to overthink these, short and honest answers are more useful than polished ones. Come back and edit anything later, this just gives us a starting point for your first session.

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Before You Continue, Please Read

Life coaching is a collaborative process focused on personal growth, goal-setting, and accountability. It is not therapy, counseling, psychiatric care, medical treatment, or legal or financial advice, and it is not a substitute for those services. I am not a licensed therapist, psychologist, physician, or attorney. Working together does not create a doctor-patient or therapist-client relationship.

Coaching outcomes depend on your own effort, choices, and circumstances outside my control. No specific result or outcome is guaranteed.

If you are experiencing a medical or mental health emergency, or having thoughts of harming yourself or someone else, please contact 911 or the 988 Suicide & Crisis Lifeline right away rather than waiting for a response here.

I have read and understand the above, and I confirm this is not a medical or mental health emergency. *

Contact Name * Email * Phone *

Background What does a typical week look like for you right now? What roles are you juggling at the moment? How would you describe your general health and energy lately?

What Brought You Here What's the situation or pattern that made you decide to start coaching? Have you tried to address this before, on your own or with someone else? What happened? On a scale of 1-10, how ready do you feel to make changes right now, and why that number?

Goals If this works the way you hope, what does life look like in three months? In a year? What would be the clearest sign to you that coaching is working? Is there anything you're afraid coaching might bring up or require of you?

Working Style Do you prefer direct feedback or a gentler approach when something isn't working? What kind of accountability actually helps you, versus what just adds pressure? Anything about how you communicate or process things that would help me work with you better?

Practical / Safety Are you currently working with a therapist, doctor, or other professional? (not disqualifying, just helpful context) Is there anything happening in your life right now, health-related or otherwise, that I should be aware of? Best way and best times to reach you outside of sessions?