Coaching Intake Questionnaire

To Maximize Our Time Together

First Name

Last Name

Telephone No. (Whats App) *

Email *

City

State

Postal code

Country

What goals or transformations are you hoping to achieve through this coaching session?

In what ways have you tried to address these challenges or goals in the past, and what were the results?

How would you describe your current emotional, mental, or spiritual state? What do you feel is holding you back from reaching your full potential?

What would a successful outcome from our session look like for you? What do you hope to take away?

Have you ever worked with a coach before? If so, what was your experience like?

On a scale of 1 to 10, with 10 being completely open and 1 being highly unsure, how would you rate your current level of readiness for this coaching journey?

Anything else that’s on your heart?

By booking and participating in coaching sessions, I agree to the following terms:

Commitment & Responsibility: I understand that coaching is a process designed to help me unlock my potential, and I commit to showing up fully for each session. I take responsibility for applying the insights and guidance I receive during coaching.
Cancellation Policy: I agree to provide at least 24 hours’ notice if I need to cancel or reschedule a session. I understand that if I fail to do so, the session will be counted as completed and deducted from my package.
No Refunds: I acknowledge that all coaching sessions and packages are non-refundable. Once booked, I agree to complete the coaching program as scheduled.
Confidentiality: I understand that everything discussed in our coaching sessions is strictly confidential. My coach will not share any of my information unless legally required to do so.
Hold Harmless & Release from Liability: I understand that my coach is not a licensed mental health professional, and coaching is not a substitute for professional mental health services. I agree that my coach is not responsible for any decisions, actions, or outcomes resulting from the coaching sessions. I release my coach from all liability related to my participation in the coaching program and any actions I take thereafter.

Coaching Is Not Therapy: I acknowledge that coaching is a future-focused process aimed at personal and spiritual growth, and is not intended to diagnose, treat, or cure any mental health conditions.