Life Coach Intake Form

Confi Coaching services and products were created "Because You Deserve a Beautiful, "Confi"dent Life."

First and Last Name

Your email*

Direct Phone Number:

Age:

Pronoun(s):

What Type Of Coaching Are You Looking for

Individuals

Couples

Family

Parental Loss

New Parent

ADHD / ASD

How Many People Are You Requesting Coaching For

List Name(s), Age(s) and Pronoun(s) of Person(s) Who'll Be Attending This or Future Sessions

What would the person(s) seeking coaching like to focus on in coaching right now?

What is currently feeling most challenging in the person(s) seeking coaching life?

What changes are the person(s) seeking coaching hoping to make?

Has the person(s) seeking coaching worked with a coach or therapist before? (Yes/No + brief context)

What does a “better life situation” look like for the person(s) seeking coaching?

What areas of life for the person(s) seeking coaching feel most out of balance right now?

What have the person(s) seeking coaching already tried to improve the situation?

What is currently holding the person(s) seeking coaching back the most?

Are the person(s) seeking coaching actively in therapy / seeing a Psychiatrist and/or Psychologist?

Are the person(s) seeking coaching currently on any medications for any of the diagnoses? Yes or No

Yes

If you answered Yes to number 10, is the person(s) seeking coaching activity and consistently taking them?

Yes

Is there anything important about the person(s) seeking coaching situation I should understand before we begin?

After clicking Submit below, please click the "Next" Button located below to go to Booking*

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