Coaching Client Intake Form-BlossomWholeWellness

Coaching Client Intake Form

First Name

Last Name

Phone Number

Coaching is a partnership where self-discovery informs where you are and where you want to go. As you go through the questions, think hard about where you are and where and how you want this journey to start. Please answer as honestly and thoughtfully as you can. There is no right or wrong way to answer these questions. There is no such thing as too much information in the Health Coaching process. A key piece to the coaching process is discovering your truth and being willing to share it.

What are the 3 biggest changes you want to make in your life over the next 5 years?

What 3 goals do you want to achieve within the next 3-6 months?

What is most important to you in your life and why?

What values do you hold true? (i.e. loyalty, compassion. wealth, family, etc)? Do you feel that you are living your values at this moment?

Rank how happy you are with your life right now on a scale of 1 to 10, with 1 being "Life is gray and dreary" and 10 being "All sunshine and rainbows"

What are those things that are getting in the way of your happiness?

Rank how stressed you feel right now on a scale of 1 to 10, with 1 being "Stress, what's that?" and 10 being "I'm a flaming ball o' stress"

What are the 3 key stressors in your life?

What would you like to get out of the coaching process?

Anything else you would like to tell me that we have not covered so far?