Coaching Intake Form

Through our coach match service we learn as much about you as possible so we can pair you with the perfect coach to help you reach your goals. Please take the time to carefully fill out the form.

Name: *

Email Address: *

Phone: *

Alternate Phone:

Birthday:

Address: *

Address 2:

Coaching Service desired: *

What goals or projects would you like to complete in the next 90 days if you were to work with a coach?

Select well defined and realistic, while somewhat challenging goals that reflect your core values — what attracts you rather than what you think you should do. What do you want to change? What do you want to outgrow? What do you want to avoid? What do you want to enhance? What kinds of transitions are you in right now?

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How do you like to be supported when appraoching challenges in your personal/professional life?:

Disclaimer: The client is aware that the coach is not a psychological counselor therapist. Coaching does not treat illness or pathology. Coaching results cannot be guaranteed. The client agrees that he/she is entering into coaching understanding that the Client is responsible for their own decisions and results. A Coach makes requests, offers suggestions, advice and opinions, and shares intuitive hunches, that may be helpful in facilitating your ongoing forward momentum. Your Coach is an equal partner in designing your action plan. When your Coach makes a recommendation for action, you always have the power to stop and renegotiate your action strategy.The Client also agrees to hold the coach free from all liability for any actions or results for adverse situations created as a direct or indirect result of a referral or other advice given by the Coach.

Client Initials: *

BE LUMINOUS YOGA
900 LENORA, STE 128
SEATTLE, WA 98121
206.682.9642 (YOGA)