Intake Form — Chaos To Clarity

LET'S GET TO KNOW YOU

First Name

Last Name

Check All That Apply:

Self Improvement

Setting and Maintaining Routines/Habits

Setting and Maintaining Boundaries

Establishing and Reaching Goals

I Just Need Help!

Intake form

1. I am open to making significant changes in my life to achieve desired outcomes.

2. I am adaptable and open to new perspectives and approaches.

3. I have a tendency to be proactive rather than reactive in addressing challenges.

4. having effective communication skills in various aspects of life is important to me.

5. I am happy with my effectiveness in balancing various priorities in my life.

6. with my current level of stress, I am satisfied with my ability to manage it.

7. with my current work life balance, I agree that changes are needed.

8. I have specific challenges or obstacles that are hindering my personal or professional growth.

9. I have been interested in coaching previously.

10. I want coaching for a specific issue/need/goal.