Client Intake Form for Relationship Coaching

I. Personal Information

First Name

Last Name

Date of Birth

Phone Number

Email Address

Preferred Method of Communication

Emergency Contact

First Name

Last Name

Phone Number

II. Relationship Status

Current Relationship Status

Single

In a Relationship

Engaged

Married

Separated

Divorced

Widowed

Other:

Length of Current/Most Recent Relationship

Number of Previous Long-Term Relationships

III. Coaching Goals

What are your primary goals for relationship coaching? (Check all that apply)

Improve communication skills

Resolve conflicts effectively

Strengthen emotional intimacy

Rebuild trust after betrayal

Navigate a breakup or divorce

Prepare for marriage or long-term commitment

Enhance self-awareness and personal growth

Improve dating skills and strategies

Co-parenting support

Other:

What specific outcomes would you like to achieve through coaching?

IV. Coaching Preferences

Preferred Coaching Format

Individual Coaching (One-on-One)

Group Coaching (Small Group Sessions)

Couples Coaching (With Partner)

Other:

Current Relationship Status

Weekly

Bi-Weekly

Monthly

Other:

Preferred Session Length

30 Minutes

60 Minutes

90 Minutes

Other:

Preferred Session Medium

In-Person

Video Call

Phone Call

Hybrid (Mix of In-Person and Virtual)

Other:

V. Services Offered

Individual Coaching Services

Self-Discovery and Personal Growth

Dating and Relationship Readiness

Healing from Past Relationships

Building Confidence and Self-Esteem

Communication Skills Development

Couples Coaching Services

Conflict Resolution and Problem-Solving

Rebuilding Trust and Intimacy

Pre-Marital Coaching

Navigating Life Transitions Together

Co-Parenting Strategies

Group Coaching Services

Relationship Skills Workshops

Support Groups for Singles

Couples Retreats and Intensives

Mastermind Groups for Personal Growth

Other Services

Customized Coaching Packages

Online Courses and Resources

Follow-Up Support and Check-Ins

VI. Client Suitability Assessment

Have you participated in relationship coaching or therapy before?

If yes, please describe your experience.

What challenges or obstacles do you anticipate in achieving your relationship goals?

Are there any mental health concerns (e.g., anxiety, depression) that may impact your coaching experience?

If yes, please describe.

Are you currently seeing a therapist or counselor?

If yes, please provide their name and contact information.

Do you have any preferences or requirements regarding your coach (e.g., gender, age, cultural background)?

What is your availability for coaching sessions?

VI. Consent and Agreement

I understand that relationship coaching is not a substitute for therapy or counseling.

I agree to the terms and conditions of the coaching services, including cancellation policies and confidentiality agreements.

I give permission for the coach to take notes and document our sessions for the purpose of providing effective coaching.

I understand that my progress depends on my commitment and active participation in the coaching process.

Client Signature:

Form Template Insight

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Below is a detailed insight into the Client Intake Form for Relationship Coaching, breaking down its purpose, structure, and the significance of each section. This analysis will help you understand how the form serves both the client and the coach in establishing a productive and tailored coaching relationship.


Purpose of the Client Intake Form

The primary purpose of this form is to:

  • Gather Essential Information: Collect demographic, relational, and personal details to understand the client’s background and current situation.
  • Identify Goals and Needs: Clarify the client’s objectives for seeking coaching and their specific challenges.
  • Assess Suitability: Determine if the client is a good fit for the coaching services offered and if additional support (e.g., therapy) may be needed.
  • Customize Services: Tailor coaching sessions to the client’s preferences, goals, and availability.
  • Set Expectations: Establish boundaries, confidentiality agreements, and mutual understanding of the coaching process.

Detailed Breakdown of Each Section

1. Client Information

Purpose: To collect basic contact details and emergency information.


Insight: This section ensures the coach can communicate effectively with the client and has a point of contact in case of emergencies. It also helps personalize the coaching experience.


2. Relationship Status

Purpose: To understand the client’s current relational context.


Insight: Knowing whether the client is single, in a relationship, or navigating a breakup/divorce helps the coach tailor their approach. For example, a single client may need dating advice, while a married client may require conflict resolution strategies.


3. Coaching Goals

Purpose: To identify the client’s primary objectives for seeking coaching.


Insight: This section helps the coach prioritize areas of focus and design a coaching plan that aligns with the client’s desired outcomes. It also allows the client to reflect on what they truly want to achieve.


4. Coaching Preferences

Purpose: To understand the client’s preferred format, frequency, and medium for coaching sessions.


Insight: This ensures the coaching process is convenient and comfortable for the client, increasing their likelihood of commitment and success. For example, some clients may prefer virtual sessions due to time constraints, while others may value in-person interactions.


5. Services Offered

Purpose: To provide a clear overview of available coaching options and allow the client to choose what resonates with them.


Insight: This section educates the client about the range of services available, helping them make an informed decision. It also allows the coach to highlight specialized areas of expertise.


6. Client Suitability Assessment

Purpose: To evaluate the client’s readiness for coaching and identify any potential barriers to success.


Insight: This section is critical for ensuring the client is a good fit for coaching. For example, if a client is dealing with severe mental health issues, they may benefit more from therapy before engaging in coaching. It also helps the coach understand the client’s history and any past experiences with coaching or therapy.


7. Consent and Agreement

Purpose: To establish clear boundaries, expectations, and legal agreements.


Insight: This section protects both the client and the coach by ensuring mutual understanding of the coaching process, confidentiality, and the client’s commitment to active participation. It also clarifies that coaching is not a substitute for therapy.


8. Signature

Purpose: To formalize the client’s agreement to the terms and conditions.


Insight: This adds a layer of professionalism and accountability, ensuring both parties are committed to the coaching relationship.


Key Benefits of the Intake Form

  1. Personalization: The form allows the coach to design a customized coaching plan that addresses the client’s unique needs and goals.
  2. Clarity: It helps the client articulate their objectives and understand what to expect from the coaching process.
  3. Efficiency: By gathering all necessary information upfront, the coach can focus on delivering value during sessions rather than spending time on administrative details.
  4. Boundary Setting: The form establishes clear guidelines for the coaching relationship, reducing the risk of misunderstandings.
  5. Suitability Assessment: It ensures the client is a good fit for coaching and identifies any additional support they may need.

How Coaches Can Use the Form Effectively

  1. Pre-Session Review: Coaches should review the form before the first session to familiarize themselves with the client’s background and goals.
  2. Session Planning: Use the information to design a structured coaching plan with measurable objectives.
  3. Progress Tracking: Refer back to the form periodically to assess progress and adjust the coaching approach as needed.
  4. Client Engagement: Use the client’s responses to build rapport and demonstrate understanding during sessions.

How Clients Benefit from the Form

  1. Self-Reflection: The form encourages clients to think deeply about their goals, challenges, and preferences.
  2. Clarity: It helps clients articulate their needs and understand the coaching process.
  3. Empowerment: By choosing their preferred services and format, clients feel more in control of their coaching journey.
  4. Accountability: The form sets clear expectations, motivating clients to actively participate in the process.

Conclusion

This Relationship Coaching Client Intake Form is a comprehensive tool that serves as the foundation for a successful coaching relationship. It ensures the coach has all the necessary information to provide effective support while empowering the client to take ownership of their personal and relational growth. By addressing both practical and emotional aspects, the form sets the stage for meaningful and transformative coaching experiences.

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