Client intake

Begin with what is true.

This is a substantial first step, not a lead form. Your answers give Keith a sense of what is bringing you here, what you are ready to examine, and what kind of support may be useful.

Rates, session format, scheduling, and fit will be discussed before any coaching relationship begins. Please answer only what you feel ready to share.

A clear boundary: Coaching is not psychotherapy, medical care, or crisis support. It is for personal development, reflection, and forward movement. If you need clinical care or are in acute crisis, please contact an appropriately licensed provider or emergency service.

Your Information

A few practical details so Keith knows who is reaching out and how to respond.

Name

Phone(optional)

Your Goals

There is no need to have a polished plan. Start with what you notice and what you hope could be different.

What brings you to coaching at this point in your life?

If this work were useful, what would change in the next six to twelve months?

What would those changes make possible for you?

What is one step you already know you may need to take?

What capacities, skills, or ways of relating would you like to strengthen?

Self-Reflection

These questions are invitations. Honest, unfinished answers are welcome.

What do you sense is holding you back?

What internal changes have you noticed recently?

How do you tend to respond when stress, conflict, or uncertainty increases?

What kind of life, presence, or relationship with yourself are you moving toward?

What personal context would help Keith meet you with greater understanding?

Share only what feels appropriate. You can leave out details you do not want to put in writing.

How You Work Best

The relationship matters. These answers help describe the kind of presence and accountability that may serve you.

What do you want from a coach's presence?

When you feel stuck or avoidant, how would you like to be supported?

Where do joy, meaning, or aliveness already show up in your life?

How will you recognize that we are making progress?

Your Commitment

Please check the commitments that feel honest for you at this point.

I will keep the appointments we agree to.I will make a good-faith effort with practices between sessions.I am willing to examine patterns that may be difficult to see.I am willing to try approaches that are new or unfamiliar.I understand that coaching is not psychotherapy, medical care, or crisis support.I will share openly enough for our work to be honest and useful.I will take consistent action toward the changes I say I want.I will involve appropriate supportive people and professional care when needed.

Signature

Date

Your responses are used to begin a conversation about fit and next steps. Submitting this form does not create a coaching relationship.