Client Intake Form (Coaching) Client Intake Form Name * Name First First Last Last Email * Phone * Tell Us About Yourself And Your Goals and/or Problem Areas * 1. What do you want to achieve or change in your life right now? 2. What values are most important to you, and how are they reflected in your current life? 3. What are your biggest strengths and how can you leverage them to achieve your goals? 4. What limiting beliefs or self-doubts are holding you back from reaching your full potential? 5. How do you define success, and how does that definition align with your personal values and aspirations? 6. What are your passions and interests, and how can you incorporate more of them into your daily life? 7. What are some of the obstacles or challenges you anticipate on your path to achieving your goals? 8. What strategies or resources have worked well for you in the past when facing similar challenges? 9. How do you handle failure or setbacks, and what can you learn from those experiences? 10. What steps can you take right now to move closer to your desired outcome? 11. How do you envision your ideal life, and what steps can you take to start creating that reality? 12. How can you create a healthy work-life balance and prioritize self-care? 13. What support or resources do you need to help you achieve your goals? 14. How can you celebrate your progress and acknowledge your achievements along the way? 15. What actions are you willing to commit to in order to create positive change in your life? Location (City/State) Best Days For Meetings (select all that apply) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Best Times For Meetings (select all that apply) 8am-11am 12pm-4pm 5pm-9pm Which Package Would You Like? New Client Intake Package (New Clients ONLY) $200 2 Meetings Per Month $150 4 Meetings Per Month $300 If you are human, leave this field blank. Submit Once your form is submitted and reviewed, you will be contacted within 72 hours. Please be sure to add admin@stjadehealing.com to your contacts so you don’t miss an email!