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Oasis Center Intake Form-Life Coaching
Please complete each question to the best of your ability. All information is kept confidential and stored according to HIPPA compliance measures.
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Full Name
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Phone
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Address
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Please list preferred availability.
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Preferred Pronouns (i.e. she/he/they)
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Employment
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Unemployed
Part-time
Full-time
Freelance
Business Owner
Have you seen a Consultant in the past? If so, please describe your experience (Include what went well/poorly/other).
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I'm seeking another perspective on... (describe current challenge).
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Rate the level of difficulty this current challenge brings to your life.
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Please describe your strengths & improvement areas.
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List 3 goals you hope to address over the course of this program.
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Add any additional information that you think would help us get to know you and support you better.
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