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Coaching Client Intake Form

Start Your Journey to Personal and Professional Growth

Welcome to Marriage by the Fire Coaching: Tailored Support for Your Growth

We’re excited to help you reach your personal and professional goals. To get started, please complete the intake form below. Your answers will help us understand your unique challenges and tailor our coaching sessions to best support your journey.

 

This is your first step toward developing stronger leadership, improved relationships, and enhanced communication skills.

 

All information is confidential and will be used to create a customized plan for your growth.

Marriage by the Fire

Coaching Client Intake Form


Preferred Method of Contact:
Email
Phone
Text
Birthday
Month
Day
Year
Marital Status:
Single
Married
Divorced
Separated

Emergency Contact:

Background Information

Goals and Expectations

What are your main goals for coaching? (Select up to three)
Have you worked with a coach or therapist before?
Yes
No

Current Situation

How would you rate your current level of satisfaction in the following areas? (1 = Very Dissatisfied, 5 = Very Satisfied)

Relationship with Spouse/Partner:
1
2
3
4
5
Career/Professional Life:
1
2
3
4
5
Personal Well-being:
1
2
3
4
5

Head Back to the Home page or Explore Our Blog for Tips and Insights to Support You. 

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