CLIENT FORM – Point on Coaching

Please Fill in Document Below.

Name *

First

Last

Gender *

Date of Birth *

Age *

Marital Status *

Children *

Cell Number *

Email *

What is your primary reason / Goal for your session/s with me? *

Please list the benefits you are expecting to gain from our session. *

Please list 3 concerns regarding the issue in order of importance.

Are there currently any significant physical/mental/emotional/spiritual challenges you feel I should know?

Are you currently under the care of a mental health care professional?

Please list any medications you are currently taking

Please list some sources of stress for you? Some examples may be, "when I don't have finances", or "when I have to publicly speak."

Client Acceptance *

ID *

Point on Coaching 2020