Appointment

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Date & Time

Time Slot

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Date & Time

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Basic Details

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Summary

Your appointment booking summary

Customer

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Service

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Date & Time

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Appointment Details

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Information Form
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Client Intake Form-2

Date :

Contact Information

Client Name

Address

City

State

Zip Code

Spouse/Partner’s Name (if applicable)

Cell Phone (include area code)

Work/Type of Business

Date of Birth (mm/dd/yyyy)

Please briefly outline any issues you would like to deal with and what you hope to achieve in the coaching setting:

Issue #1

Issue #2 (if applicable)

Issue #3 (if applicable)

Please answer the following to let me get to know you a bit better:

I would describe myself as

Others would describe me as

The three things that I like most about my life/situation are

If I could change three things about my life/situation, they would be

My three greatest accomplishments (so far) are

Disclaimer: The Client is aware that the coaching relationship does not represent psychological counseling or any kind of therapy. The Client is also aware that coaching results can vary and are not guaranteed. The Client agrees that they are entering into coaching with the understanding that the Client is responsible for their own decisions and results. The Client also agrees to hold the Coach free from all liability for any actions or results of adverse situations created as a direct or indirect result of advice given by the Coach.

I Accept

Session Contact Procedure: The Coach shall contact the Client at the agreed hour. If the Client fails to make the appointment time, the Client is still responsible for the coaching fee, unless 24 hours' notice has been given to reschedule the call. The Coach will reschedule with the Client. All session fees must be made 24 hours prior to the session.

I Accept

Client Signature