Name * First Name Last Name What name do you like to be called (i.e., nickname that you'd rather I use)? * What is the preferred email to use when contacting you? (This should be an email you don't mind receiving emails of personal nature.) * Phone (###) ### #### Are you okay with receiving texts at this phone number? Yes No Why are you looking for a coach? * If I could grant you three wishes during our time working together, what would they be? * What would it give you or do for you to have/accomplish these things? * What is your biggest challenge to having/accomplishing these things? * What else would you like me to know about you? * NOTE: Since regular email is not generally a secure form of communication, I may ask you when we talk if you have ever or are currently (1) receiving any mental health services (e.g., counselling, therapy) or (2) taking any psychotropic or psychiatric medications. This information may be important for me to understand so that I can coach ethically and effectively, and I want to protect your personal information at all times. Thank you! New Client Intake Form
