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Life Coaching Client Intake Form

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Updated on September 4th, 2023

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

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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 INFORMATION

Client Name: _____________________

Address: __________________________________________

Phone: _____________________ E-Mail: _____________________

Date of Birth: _____________________ Marital Status: _____________________

How did you hear about us? _____________________________________________

SELF-ASSESSMENT

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

SELF-DESCRIPTION

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

Signature: _____________________________ Date: ____________________

Printed Name: ____________________

Initial Consultation

The initial consultation, often called a discovery or intake session, is an opportunity for the life coach and a new client to introduce themselves and gauge their level of rapport. Many life coaches offer the first session free of charge to allow both parties to see if they are a good fit before committing.

A first session may go something like this:

  1. The life coach reviews the client intake form and discusses some of the client’s responses with them.
  2. The coach explains how their coaching process works and what the logistics of future sessions will be.
  3. The client will be asked to further explain what they hope to achieve through the sessions.
  4. If both parties want to work together, they will set up the appointment, and the coach might assign some “homework” for the client to complete for the next session.

Related Forms (1)

Personal Training Client Intake Form – An intake for use by personal trainers to help clients meet their fitness goals.

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