Life-Coaching Intake Form
Please take your time when completing this form. Answer with full honesty, provide as much detail as you would like that you think would help us during our sessions. The first 4 questions will help me create your astrological birth chart to better understand you. The report will be shared with you if you are interested.
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Cancellation Policy:  If you need to reschedule or cancel your appointment, please notify us at least 48 hours in advance. Any sessions cancelled without 48 hour notice will forfeit session fee. 

By placing your initials below, you agree to the Cancellation Policy for this session and future sessions. This is required for any and all sessions booked.

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Terms & Conditions: It is my choice to receive coaching through YOMEI. I have completed this form to the best of my knowledge. I understand that practitioners do not diagnose illness, disease, or physical or mental disorders, nor do they prescribe medical treatments or pharmaceuticals. I acknowledge that these sessions are not a substitute for medical examination, professional counseling, or diagnosis, and that it is recommended I see a primary health care provider for those services. By typing my name below I agree to the terms and conditions are accepted and agreed upon:
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Name
Date of Birth,
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DD
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Place of Birth (City, State)
Exact Time of Birth (if you do not know leave blank)
Why are you seeking Life-Coaching services?
What do you want to get out of Life Coaching?
Where are you now in comparison to where you want to be?
What are things that you feel are hindering you from being where and who you want to be? 
What changes would you like to see in your life? What do you feel is hindering you the most from making those changes?

What do you value most in life? Do you feel that you currently have what you value most?

On a scale of 1-10 how would you rate your happiness right now?
Not happy
The Happiest I Have Ever Been
Clear selection
What makes you most happy
On a scale of 1-10 what is your current stress level?
Not Stressed at All
Extremely Stressed
Clear selection
What is causing your stress? Be specific.
Who are the most important people in your life, and what is your relationship to them?

Imagining yourself at the end of your coaching experience, what is different in your life? How have you changed?

What does success look like to you?
How have you overcome challenges in your life?
What is your biggest accomplishment(s)? Why are you proud if this accomplishment?
What previous options have your tried to help you get through this challenge (that lead you to life-coaching)?
What tools would you like to walk away with? Why?
Do you have any medical or psychological conditions? If yes, please describe. *
Cancellation Policy:  If you do not cancel within 48 hours of your scheduled session you forfeit your session cost. If you are on a session plan, you lose one of your sessions.

By providing your initials below, you agree to the cancellation policy.
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My purpose to seeking the advice of YOMEI is done so for educational and personal purposes only. I understand that YOMEI does not diagnose illness, disease, or mental disorder. Nor do they prescribe medical treatment or pharmaceuticals. It has been made clear that my session is not a substitute for medical examination or diagnosis and that it is recommended that I see a licensed practitioner or  doctor for any physical or mental ailment.

I agree that YOMEI cannot be held liable for any problems that might arise that I think could be attributed to our sessions. I have stated all of my known medical conditions and if necessary I will keep YOMEI updated on my physical, mental, and emotional health. I acknowledge that YOMEI practices for the purpose of providing mental/emotional/physical and spiritual support through multiple techniques. I attest that I understand the nature of the session and freely elect to receive the techniques. I release YOMEI from any and all claims of malpractice, non-disclosure, or lack of informed consent.

By entering your name, you agree to the Informed Consent. 

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