Relationship Coaching Client Intake Form

I. Personal Information

First Name

Last Name


Date of Birth

Gender

Street Address

City/Suburb

State/Province

Postal/Zip Code


Phone Number

Email Address


Preferred Method of Communication

Occupation

II. Relationship Status & History

Current Relationship Status

If in a relationship, partner's name (optional)

Length of Current Relationship (if applicable)

Previous Relationship History (brief overview)

Are you currently in therapy or counseling?

Have you participated in relationship coaching before?

III. Coaching Goals & Objectives

What are your primary goals for relationship coaching? (Please be specific)

What specific challenges are you currently facing in your relationships?

What would a successful coaching outcome look like for you?

What are your top three priorities for our coaching sessions?

What areas of your relationship(s) would you like to focus on?

What strengths do you bring to your relationships?

What are your biggest fears or concerns about your relationships?

What do you believe is currently preventing you from having the relationships you desire?

IV. Coaching Services & Suitability

Please indicate which coaching services you are interested in.


Individual Coaching

Group Coaching

Couples Coaching (if applicable)

V. Suitability Questions

Are you willing to commit to regular coaching sessions and complete assigned exercises?

Are you open to honest and constructive feedback?

Are you willing to take responsibility for your own actions and behaviors in relationships?

Do you have any history of domestic violence or abuse (as a victim or perpetrator)?

Note: If abuse is present, individual therapy or specialized support may be more appropriate than relationship coaching.


Do you have any current mental health diagnoses that might impact your ability to participate in coaching?

Note: Coaching is not a substitute for therapy. If you have significant mental health concerns, please consult with a mental health professional.


Are you seeking coaching as a last resort to save a relationship where abuse, or addiction is present?

Note: If this is the case, coaching may not be the best solution. It is recommended to seek professional help from a therapist who specialises in those areas.


Are you looking for someone to tell you what to do, or are you looking for guidance to find your own answers?

What are your expectations of a relationship coach?

What is your preferred learning style?

What times and days are you generally available 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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Important Considerations:

  • Legal and Ethical Compliance: Ensure your intake form and coaching practices comply with all relevant legal and ethical guidelines.
  • Privacy: Handle client information with utmost confidentiality and in accordance with privacy laws.
  • Professionalism: Maintain a professional and supportive demeanor throughout the intake process.
  • Customization: Adapt this form to fit your specific coaching niche and target audience.
  • Follow-Up: After receiving the completed form, schedule a consultation to discuss the client's needs and determine suitability for coaching.

This comprehensive form will help you gather the necessary information to effectively serve your clients and build a strong foundation for your coaching relationship.


Let's dissect this Relationship Coaching Client Intake Form to understand its purpose and the rationale behind each section:


Overall Purpose:


The primary goal of this intake form is to:

  • Gather comprehensive client information: This includes personal details, relationship history, and coaching goals.
  • Assess client suitability: It helps determine if the client's needs and expectations align with the coach's services and expertise.
  • Establish a foundation for the coaching relationship: It sets the stage for open communication, trust, and a clear understanding of expectations.
  • Provide a basis for service selection: It allows the client to identify the service they would like to undertake.

Detailed Section Breakdown:


Section 1: Personal Information


Purpose: Establishes basic contact information and demographics.


Insight: This section is crucial for administrative purposes and helps the coach understand the client's background.


Why it matters: Accurate contact details are essential for communication. Date of birth can provide context for life stages. Occupation can offer insights into potential stressors or time constraints. Referral sources help with marketing analysis.


Section 2: Relationship Status & History


Purpose: Provides context for the client's current relationship situation and past experiences.


Insight: This section helps the coach understand the client's relationship patterns, challenges, and potential triggers.


Why it Matters: Understanding relationship history is vital for tailoring coaching strategies. Previous therapy or coaching experience can indicate the client's level of self-awareness and willingness to engage in personal growth.


Section 3: Coaching Goals & Objectives


Purpose: Identifies the client's specific needs, desires, and expectations for coaching.


Insight: This is the core of the intake form. It reveals the client's motivations, challenges, and desired outcomes.


Why it Matters: Clear goals and objectives are essential for effective coaching. They provide a roadmap for the coaching process and allow for progress tracking. The questions are designed to get the client to think deeply about their situation.


Section 4: Coaching Services & Suitability


Purpose: Outlines the available coaching services and assesses the client's readiness and appropriateness for coaching.


Insight: This section allows the client to choose the most suitable service and helps the coach identify any potential red flags or areas of concern.


Why it Matters:

Service Selection: Enables clients to choose the coaching format that best suits their needs.


Suitability Questions: These questions are critical for ensuring the client is a good fit for coaching. They address issues such as:

  • Commitment: Willingness to engage in the coaching process.
  • Openness: Receptiveness to feedback and self-reflection.
  • Responsibility: Taking ownership of their actions and behaviors.
  • Safety: Identifying potential risks like domestic violence or abuse.
  • Mental Health: Recognizing any underlying mental health concerns that might require professional therapy.
  • Expectations: Making sure the client has realistic expectations of the coaching process.
  • Learning Style: Helps the coach tailor their coaching style.
  • Availability: Helps with scheduling.

Section 5: Terms & Conditions (Brief Overview)


Purpose: Provides a high-level overview of the coaching agreement.


Insight: This section sets clear boundaries and expectations for the coaching relationship.


Why it Matters: It protects both the coach and the client by outlining key policies and procedures. Full legal agreements should be given to the client separately.


Section 6: Signature


Purpose: Formalizes the client's agreement to the information provided.


Insight: It demonstrates the client's commitment to the coaching process.


Why it Matters: It provides a record of the client's consent and understanding of the intake form.


Key Strengths of this Form:

  • Comprehensive: It covers a wide range of relevant information.
  • Client-Centered: It focuses on the client's needs, goals, and experiences.
  • Suitability Focused: It includes questions to assess the client's readiness for coaching.
  • Service Variety: It offers a range of coaching options to meet diverse needs.

Areas for Potential Enhancement:

  • Digitalization: Consider creating a digital version of the form for easier completion and data management.
  • Language Clarity: Ensure the language is clear, concise, and accessible to a wide audience.
  • Cultural Sensitivity: Consider cultural differences and adapt the language and questions accordingly.
  • Specific Service Forms: Depending on the service, you may want to create more specific intake forms. For example, a pre-marital coaching intake form may have very specific questions pertaining to that service.
  • Follow up questions: Consider adding follow up questions to some of the answers that the client provides.

By understanding the purpose and rationale behind each section, you can effectively use this intake form to build strong and successful coaching relationships.


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