Life Coaching Client Intake Form

A life coaching client intake form is used by life coaches to gain insight into new clients before their first session. The responses provided by the client will help the coach understand their current situation, how they want to change, and what they hope to achieve through the sessions. Using this information, the life coach can customize a plan that meets the client’s needs.

Importance of Using an Intake Form

Requiring life coaching clients to complete an intake form before their first session has the following benefits:

1. Time efficiency – Getting the info upfront means coaches can focus on solutions in the first session.
2. Finding the right approach – The coach can adapt their approach and strategy to the needs and tone of the client.
3. Gauging client commitment – The client’s responses can help the coach determine their level of commitment and willingness.

Contents

Sample

LIFE COACHING CLIENT INTAKE FORM

DISCLAIMER: Thank you for your interest in being a client of [LIFE COACH’S NAME] . Information collected about new clients is confidential and will be treated accordingly.

Client Name: _____________________

Address: __________________________________________

Phone: _____________________ E-Mail: _____________________

Date of Birth: _____________________ Marital Status: _____________________

How did you hear about us? _____________________________________________

Select the appropriate checkbox to indicate your agreement with each of the following statements:

I am optimistic.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

I am satisfied with my life.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

I am satisfied with my health.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

I am satisfied with my financial situation.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

I am satisfied with my social life.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

I feel good about my personal relationships.
☐ Disagree ☐ Somewhat Agree ☐ Agree ☐ Strongly Agree

What are your three most significant accomplishments?
_____________________________________________

What are your three most significant disappointments?
_____________________________________________

Describe your top three strengths.
_____________________________________________

Describe your most aggravating weakness.
_____________________________________________

I am happiest when I…
_____________________________________________

I am happiest when I…
_____________________________________________

How would you describe your state of health?
_____________________________________________

How would you describe your state of well-being?
_____________________________________________

If I could do anything, I would…
_____________________________________________

Describe any goals or desires that you have yet to feel?
_____________________________________________

What has hampered you from achieving your goals?
_____________________________________________

People like me because I am…
_____________________________________________

Signature: _____________________________ Date: ____________________

Printed Name: ____________________