Wellness Coaching Intake Form 2023-2024
Wellness Coaches are here to help you find the motivation and tools that you need to meet your health-related goals. Wellness Coaches are not therapists or psychologists and services may not be right for all students.  If you believe that depression, anxiety, or other mental health disorders may be a factor for you, please visit the Skidmore Counseling Center.

The questions on this intake form will provide us with information about your reasons for seeking Wellness Coaching services as well as a preliminary sense of how suitable this service is given your needs.  After you submit your form you will be contacted by email within 2 business days regarding next steps.
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Please share the name that you prefer to be called:
What is your Skidmore email address?

Please provide your cell phone number:
What are your pronouns?
What is your class year?
Clear selection
How did you hear about Wellness Coaching?
Were you referred to Wellness Coaching by Skidmore's Counseling Center?
Clear selection
Wellness Coaching is an individualized approach that is most effective at helping students to target specific, concrete goals.  With this in mind, please select up to three areas that you hope to focus on with your coach.
Please share a bit about why you want to focus on the topics that you selected.
Please indicate your general availability below.  Your coach will be in touch to offer time options that fit your preferences.
Monday
Tuesday
Wednesday
Thursday
Friday
Morning (before 10am)
Late morning (10am-12pm)
Early afternoon (12pm-2pm)
Afternoon (2pm-4pm)
If you have a request for a specific Wellness Coach please specify.
Clear selection
Is there anything else that you would like to share with us?
Submit
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