Whole Life Intake

1
About You
2
Steward
3
Nourish
4
Center
5
Cultivate
6
Connect
7
Goals
✓
Done

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About You

Let's start with the basics so your coach can get to know you before your first session.

First Name *

Last Name *

Email Address *

Phone Number

How did you find me?

What inspired you to seek coaching right now? What's happening in your life that made this feel like the right time?

What does your ideal outcome from coaching look like? Paint a picture of what success looks and feels like for you.

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Center — Soul & Mindset

The inner life is the foundation of everything. Let's explore your values, faith, and emotional landscape.

How would you rate your current emotional and spiritual health? 1 = Depleted / disconnected · 10 = Grounded, at peace, and growing

1 — Depleted10 — Grounded

How would you describe your faith life right now? This could be spiritual practice, religious community, or personal belief — share what's true for you.

What are your 3–5 core values? What matters most to you? What do you want to be known for?

Do you currently have margin and rest built into your life?

Yes, intentionally

Some, but not enough

No — I'm overextended

I'm not sure what that looks like

What limiting beliefs or mindset patterns do you want to address? What stories do you tell yourself that hold you back?

What brings you the most joy?

What would emotional wholeness look like for you?

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Coaching Goals & Final Thoughts

You've done the hard work of honest reflection. Let's close with your intentions for this coaching journey.

Overall, how would you rate your whole-life satisfaction right now? 1 = Significantly struggling across the board · 10 = Deeply fulfilled and thriving

1 — Struggling10 — Thriving

What are your top 2–3 priorities for our coaching work together? Based on everything you've just reflected on — where do you most want to focus?

What does success look like at the end of our coaching relationship?

Is there anything else you'd like me to know before our first session? Anything important that didn't fit elsewhere — this is an open space.

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Thank You for Sharing

Your intake form has been received. Your honesty and openness take courage — and they are the very foundation of meaningful change.

Your coach will review your responses and reach out soon to schedule your first session. Until then, take a deep breath. You've taken a beautiful first step.

About You

Steward — Financial Wellness

Nourish — Body, Nutrition & Wellness

Center — Soul & Mindset

Cultivate — Scheduling & Household Operations

Connect — Relationships & Community

Coaching Goals & Final Thoughts

Thank You for Sharing