Starseed Coaching Intake Form 
Agreement/Reminder

I understand that all the information I entered in this form will be considered strictly confidential.
The data gathered from this form will only be used as a basis for the type of coaching the client will need.
I understand that in order to be successful, it is vital to follow the plan agreed by both the client and the life coach.
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Client First and Last Name *
Email *
Client Date of Birth *
Gender *
Phone Number
Address *
Marital Status *
Required
Occupation *
What are your personal goals? *
What are your professional goals? *
What changes would you like to make in your life right now? *
What are the things that make you sad? *
What are the things that make you happy? *
What motivates you in life? *
What are you willing to do to achieve your goals? *
What would you say are your Strengths, Weakness, Opportunities and Threats (Personal and/or Professional S.W.O.T. Analysis)? *
What are your expectations for this coaching relationship? *
Are you currently taking any medication? *
Required
If yes, please indicate the reason below:
Do you have any health conditions you would like to share? *
Required
If yes, please share below:
Please share your ideal future reality based on the goals you want to accomplish? *
What is your preferred availability for sessions? For example, Morning, Afternoon, Weekly Sessions *
How did you find out about this service? *
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