New Client Intake Form — Navigating Gracefully

1

Client Information

Client Name*

Preferred Name

Pronouns

Date of Birth

Age

Gender

Relationship Status

Children / Ages

Occupation

Employer / School

Phone*

Email*

Address

City

State

ZIP Code

2

What Kind of Coaching Are You Looking For?

Select all that apply.

3

What Brings You to Life Coaching?

What is happening in your life right now that led you to seek life coaching?

What feels most important for us to focus on first?

If coaching is helpful, what would you hope feels different in the next three to six months?

4

Strengths, Support & Resources

Who are the important people in your life or support system?

What strengths, values, experiences, or qualities have helped you navigate difficult seasons?

What activities, practices, relationships, or routines help you feel grounded and energized?

5

Life Areas & Current Priorities

Which areas would you like to strengthen or create change in? Check all that apply.

Which of these areas feels most urgent or important right now?

What have you already tried? What has helped, and what has not?

6

Coaching Style & Accountability

What tends to help you make progress? Select all that apply.

7

Values, Faith & Personal Context

What values are most important to you in this season of your life?

Is faith or spirituality important in your life?

YesNoUnsure

If yes, how would you like — or not like — faith/spirituality incorporated into life coaching?

Are there family, cultural, identity, or life experiences that would be helpful for your coach to understand?

8

Coaching Scope & Additional Support

Are you currently working with a therapist, counselor, medical provider, attorney, or other professional?

YesNo

If yes, please describe if relevant to coaching.

Is there anything currently happening that may require support outside the scope of life coaching?

YesNoUnsure

If yes, please explain.

9

Life Coaching Goals

What are the top three goals you would like to work toward through life coaching?

What would progress look or feel like to you?

What is one change you feel ready to begin making now?

10

Preferences & Additional Information

What is most important for your life coach to know about how you like to communicate, learn, and be supported?

Is there anything else you would like to share as we begin?