Nickname/Preferred to be called

Company name (if applicable)

Email

Service used TODAY

Age

Birthplace

Referred by

How did you hear about Body-Centered Life Coaching?

1. What issue do you want support with today?

2. What is the desired outcome from working together?

3. What emotional challenges have you faced in the past and are facing currently?

4. Do you have a spiritual practice? Please explain.

5. What is your historic and current relationship with your body? Do you feel you live in your body? Comment on your physical exercise, your body as friend or foe, and your nutritional habits.

6. In what circumstances or by what actions do you feel most safe?

7. What activities, actions or circumstances bring you a sense of awe or pleasure? (And these are not necessarily dependent on someone else, i.e., fresh flowers in you home, a relaxing hot bath, reading, walking in nature).

8. What is your purpose in Life?

New Client Intake Questionnaire