top of page

HOME
ABOUT
COACH WTH ME
EVENTS
BLOG
CONTACT

Use tab to navigate through the menu items.

To make the most of our time together and to ensure we understand your current needs and health status, we kindly ask that you complete this form in advance.

SESSION INTAKE FORM

First name*

Last name*

Contact Number*

Email*

Date of Birth

Place of Birth - Town/City and Country

Time of Birth*

:

For your clarity, Human Design Coaching sessions consist of the coach helping to guide the client from where they are now to where they would like to be. Coaching is not a form of counselling or therapy.

Be You & Thrive Life Coaching has a holistic approach.

Have you had any previous coaching in the past?

Yes

No

What are the reasons you are looking for coaching?

How much water do you drink on a daily basis?

How is your diet?

Poor

Fair

Good

What is your preferred form of physical movement?

How is your general health?

Poor

Fair

Good

If poor, please state reason’s ……..

How is your blood pressure?

High

Low

Don't know

Are you taking any medication?

Rate how present any of the following issues are in your daily life….

Anxiety

1

2

3

4

5

6

7

8

9

10

Stress

1

2

3

4

5

6

7

8

9

10

Depression

1

2

3

4

5

6

7

8

9

10

Apathy

1

2

3

4

5

6

7

8

9

10

Low self-esteem

1

2

3

4

5

6

7

8

9

10

Low energy

1

2

3

4

5

6

7

8

9

10

Lack of direction

1

2

3

4

5

6

7

8

9

10

Struggle to make decisions

1

2

3

4

5

6

7

8

9

10

Overwhelm

1

2

3

4

5

6

7

8

9

10

Poor Boundaries

1

2

3

4

5

6

7

8

9

10

How are you presently managing these issues in our life?

What methods are you using?

What do you find stressful in your life?

Do you have lows and what triggers them?

How is your focus ?

What is your biggest struggle with yourself at the moment?

What is holding you back?

What is accelerating you forward?

What do you celebrate about yourself?

What are you grateful for?

What is it that you most want in your life?

Do you follow your moon cycle?

Yes

No

What day are you currently on?

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

Winter

Spring

Summer

Autumn

How self-nurturing would you say you are?

1

2

3

4

5

6

7

8

9

10

How would you rate yourself as a do’er or a high achiever?

1

2

3

4

5

6

7

8

9

10

Do you feel you are living your life on your own unique purpose?

Yes

No

Please note anything else, you feel I may need to know…

bottom of page

SESSION INTAKE FORM

© 2023 Lucy Pople. Privacy I Terms & Conditions I WebDesign I Photography