Client Goal Intake Form

Please fill out these questions as accurately and thoughtfully as possible as they will drive the goals we set out for your program.

First name

Last name

What goals/life changes are at top of mind as we begin working together?

What are your main motivations when thinking about those goals?

What’s holding you back from reaching those goals right now?

How is your body reacting to your current life situation (stressed, overweight, malnourished, tense, anxious, etc)?

Do you remember a time when life and work felt the most fun and rewarding? What were you doing? Describe the circumstances around that time.

What is the hardest thing in your life that you have had to overcome?

What do you love most about your life, current role, job, or business you’ve created?

Who are the key people in your life and what are their roles?

What is your relationship/connection to God (if any)? Please describe.

If you could change anything about your life in the next 12 months, what would it be?

Is there a dream or goal that you have set aside or a path not taken that you think often about?

Where do you see yourself in five years regarding your business and personal life (personal growth, dreams you have created, relationships etc)?

What do you hope to achieve in the next 6 months as a result of hiring me as your coach?

If we look back 12 months from now, and our time together has been even more successful than you hoped, what specifically will be different about your life?

Is there anything else you think is important for me to know before we get started?

Client Goal Intake Form

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