Client Intake Forms — Imagine Life Design Coaching With Mary Mcevilly-Hernandez

Client Intake Forms

PLEASE COMPLETE THE questions below and click submit.

If you have any questions or challenges, reach out to me at mary@imaginelifedesign.com.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(Digits only, no dashes)

Name of Spouse or Significant Other:

Name and Ages of Children (or N/A):

What is the most important thing I should know about you right now?

What are you looking for from the coaching experience?

Have you ever been in a coaching program before? If yes, what was the experience like for you?

How can your coach best support you during the coaching relationship?

What would you like your coach to do if you struggle with your goals?

How will you know when you are receiving value from the coaching process?

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

Who in your life do you consider a support system and why?

Describe 3 peak moments/experiences from your past.

What are your current stressors and obstacles to moving forward?

How do you get in your own way?

What is the greatest challenge you have had to overcome?

Where are you on your spiritual journey? What are your current practices?

Do you currently meditate? Have you ever meditated?

How would you describe your overall health?

Are you currently under the care of a mental health professional, psychologist, or psychiatrist? If yes, what are they treating your for? Are you on any medications?

Additional information your coach should know: