JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Coaching/EFT client intake form
This is a standard intake form I use with all of my clients.
While you may not have the answer to all of these questions and it’s okay to note that, the more of these questions you can honestly and authentically answer, the more successful our sessions together will be.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What are your greatest strengths and successes in life?
*
Your answer
What are your biggest challenges in life?
*
Your answer
If you could do or be anything or anyone without limitations, what would you be doing or who would you be?
*
Your answer
What would you like to focus on now?
*
Your answer
What negative thoughts and feelings are coming up now &/or regularly for you?
*
Your answer
What is your negative self talk &/or feelings about what you are focusing on?
*
Your answer
Is there any dogma from your culture, community or religion about this? If so, what does it say?
*
Your answer
When this issue comes up, what do you feel in your body and where do you feel it?
*
Your answer
What is your earliest memory of this feeling, and when did you experience it most recently?
*
Your answer
Who do you blame or hold responsible for this feeling?
*
Your answer
Who has modeled or demonstrated this same behavior or feeling in your life?
*
Your answer
What limiting beliefs or patterns did you develop based on this?
*
Your answer
What benefits do you get by holding these beliefs? What do you get by acting in alignment with this, i.e. does it keep you safe, or happy, what do you gain?
*
Your answer
On a scale of 1 to 10, with one being least and 10 being most, what is the intensity level of this experience when it comes up?
*
Least intense - little interference
1
2
3
4
5
6
7
8
9
10
Most intense - major interference
Imagine if you were completely free of and over this feeling: What would that be like for you? Who would you be and how would you be living differently in your life?
*
Your answer
Looking at your beliefs, if you knew you were limitless and you can believe anything, what beliefs would you like to choose to believe instead of these beliefs?
*
Your answer
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
