Intake Form Please provide the following information and bring it to your first session. Information you provide here is protected as confidential information. Name: (Last) (First) (Middle Initial).
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How to fill out the Coaching Intake Form online
Filling out the Coaching Intake Form online is a crucial step in preparing for your first coaching session. This comprehensive guide will provide you with clear instructions to ensure that you complete the form accurately and efficiently.
Follow the steps to complete the Coaching Intake Form
- Click the ‘Get Form’ button to access the form and open it in your preferred online document editor.
- Begin by entering your name in the designated fields, including last name, first name, and middle initial. If you are under 18 years old, also provide the name of your parent or guardian.
- Input your birth date in the specified format, and select your marital status by checking the appropriate box.
- Fill in your age and gender by selecting from the given options.
- If applicable, include the name of your spouse in the corresponding fields. Additionally, list any children along with their ages.
- Provide your occupation and the highest level of education achieved.
- Enter your complete address, including street number, city, state, and zip code.
- Fill in your home and cell phone numbers. Indicate if you allow messages to be left on both numbers.
- Provide your email address and confirm if you consent to receive emails.
- If referred by someone, include the name of the person who referred you.
- Indicate whether you have previously received mental health services and, if so, provide details about when and from whom.
- State if you are currently taking any prescription medications, and if so, list them.
- Assess your general health and mental health by answering related questions and providing additional details as required.
- Complete the sections related to emotional well-being, exercise frequency, and any significant life changes.
- Review the symptoms list and check off any you are currently experiencing.
- Disclose any family mental health history by marking yes or no for each category, and list any family members as appropriate.
- Provide additional information regarding your employment, spirituality, strengths, weaknesses, and your goals for therapy.
- Designate an emergency contact by providing their name, relationship to you, phone number(s), and address.
- Once the form is completed, save your changes, download a copy for your records, print it out, or share it as necessary.
Start filling out your Coaching Intake Form online today!
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