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Empower Wellness Passionately.

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Are you results driven? Learn how you can impact a life in their healing journey through sponsoring them with one of our vetted coachs or therapists. You can be the supportive tool someone needs to access their full potential.

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Join our volunteer community of gifted coaches, or ask about opportunities within our office staffing team. Your time and talent is greatly appreciated. Be a part of something AMAZING !

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Coaching Intake Form

Full Name

Preferred Name/Nickname

Contact Number

Date of Birth

Occupation

Preferred method of contact

Section 2: Background Information

Briefly describe your current life situation and any recent major events or changes.

What motivated you to seek out a life coach at this point in your life?

Section 3: Goals and Challenges

Please list and describe three primary goals you hope to achieve through our coaching relationship

What challenges or obstacles are currently standing in the way of you reaching these goals?

Section 4: Previous Coaching/Therapeutic Experiences

Have you worked with a coach or therapist before? If yes, please share briefly about that experience. What was helpful, and what was less so?

Section 5: Expectations and Preferences

What are your expectations from this coaching process?

What do you expect from me as your coach?

What kind of support do you find most helpful (e.g., encouragement, accountability, resources, direct feedback)?

What are your preferred days and times for our coaching sessions?

Section 6: Self-Assessment

On a scale of 1-10, how would you rate your current stress level?

. On a scale of 1-10, how would you rate your current level of satisfaction with your life?

What three words would describe how you feel about your life right now?

Section 7: Agreement By submitting this form, you acknowledge and agree to the following: You understand and agree to the terms of our coaching relationship (to be outlined in detail

in the coaching agreement), including fees, scheduling, confidentiality, and cancellation policies.
You are committed to the coaching process, including the work outside of our sessions.
You understand that coaching is not therapy, does not substitute for therapy if needed, anddoes not prevent, cure, or treat any mental disorder or medical disease.

Be a Part of Something Amazing

Be the Difference in Transforming a Life
Empower Wellness Passionately.

Donate Monthly

Sponsor

Fundraising

Volunteer

Partner

Coaching Intake Form

Sign up for our newsletter

Become a sponsor

Fundraising

Volunteer

Become a Partner

Be a Part of Something Amazing

Be the Difference in Transforming a Life Empower Wellness Passionately.

Donate Monthly

Sponsor

Fundraising

Volunteer

Partner

Coaching Intake Form

Become a sponsor

Fundraising

Volunteer

Become a Partner

Be the Difference in Transforming a Life
Empower Wellness Passionately.