Client Engagement Forms

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you worked with a coach before?

Yes

No

What forms of support do you currently have?

Therapist or counselor

Supportive friends/family

Support group

Medical or mental health provider

Other

Consent & Coaching Agreement (see link at top & bottom of this form)

*

I understand that coaching is not therapy. It focuses on present and future goals. I consent to participate in trauma-informed coaching with the understanding that deep trauma processing may be referred to a licensed therapist.

*

I have read, understood, and agree to the terms of the coaching agreement.

Date *

MM

DD

YYYY