Coaching Intake Form Name * First Name Last Name Email * Phone * (###) ### #### I would like to first focus on * Life Coaching – Unlock your full potential and create the life you desire. Relationship Coaching – Strengthen personal connections and build healthier relationships. Employment Coaching – Gain confidence in your career path and job search. Wellness Coaching – Achieve balance, reduce stress, and improve overall well-being. Business Coaching – Develop leadership skills and grow your business with strategic guidance. Team Coaching – Enhance collaboration, productivity, and workplace success. Holistic Coaching – Align your mind, body, and spirit for a fulfilling, purposeful life. Youth Coaching – Empowering young individuals to navigate challenges, build resilience, and embrace their true potential. (Special focus on peer pressure, bullying, and self-love.) Other or Unsure How did you hear about us? Who can we thank for the referral? Website Google Search Social Media Event Advertisement Specific Person Marital Status Married Divorced Widowed Single Partner It's Complicated Do you have Children? No children Yes, they live elsewhere Yes, they live at home Occupation What do you expect to get out of these coaching sessions? Tell me something about yourself that you think I should know to coach you better. Where would you like to see yourself in 1 year | 5 years | 10 years? What is the first thing you would like to change, improve or develop on your walk? * I prefer our sessions to be Once a week Twice a week Every other week Monthly Other or Unsure Would you like your sessions to be In person at my location In Person at the NewBeginnings Office Virtual (Phone call and or Video chat) Other or Unsure This agreement is entered into between New Beginnings Health and Wellness Center and the above-named client. It will commence on the start date indicated above and continue on a monthly basis for 12 months, or until such time as the client or coach terminates the services. A reminder email will be sent 48 hours prior to any scheduled session. The next month’s session will be scheduled during the current coaching session unless otherwise arranged. Cancellation Policy Clients may cancel payment at any time prior to the billing date for the next month’s sessions. Cancellation must be submitted in writing via email to our office, and the request must be received before the new billing cycle begins. If not received on time, the client will be charged for that month’s coaching session. If an appointment needs to be rescheduled, please notify our office at least 24 hours in advance. Failure to do so may result in the forfeiture of that session. Services Coaching sessions will be conducted on the agreed upon schedule via telephone unless otherwise agreed upon. The coach will call at the agreed-upon time. If the client does not answer, the coach will attempt one callback within five minutes. If there is no answer on the callback, the session will be considered canceled for that session. The purpose of the coaching sessions is to support the client in reaching their goals, utilizing the coach’s years of experience in personal development. Services may include, but are not limited to: brainstorming techniques, action plan development, follow-up procedures for client motivation, education, and a Q&A format to explore solutions. Termination The coaching agreement may be terminated at the discretion of the coach if an impasse is reached, or if the client fails to adhere to the Coaching Success Guidelines. As long as both the client and coach uphold their respective commitments and adhere to professional standards, the relationship will continue. Examples of terminable offenses include: Non-payment of coaching fees Failure to adhere to Coaching Success Guidelines Lack of engagement or indifference toward agreed-upon action items Confidentiality All communication between the coach and client is confidential. Information shared during coaching sessions will not be disclosed to any third party without the client’s consent, except in cases where the client discloses illegal, unethical, or criminal activities. Disclaimer The coaching methods employed by New Beginnings Health and Wellness Center do not guarantee specific outcomes. They serve as guidelines to be followed by the client to facilitate personal growth. The client agrees to hold the coach and New Beginnings Health and Wellness Center free from any liability related to the advice given during coaching sessions. By signing/agreeing below, you acknowledge that you have read and agree to the terms outlined in this agreement. I agree and Consent I do NOT agree and consent Thank you!
