Let’s Collaborate!Complete & submit the New Client Intake Form Name * First Name Last Name Date of birth * MM DD YYYY Email * Phone * Country (###) ### #### Preferred Contact Method * Phone Text Message Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about us? Referral Website Social Media Search Engine Other Are you looking for in-person or virtual sessions? In-Person Virtual Hybrid When would you like to start? MM DD YYYY What services are you interested in? Life Coaching Mentoring Health & Wellness Bitcoin Education Other If other, please specify: What coaching packages are you interested in? 30-minute Introductory Session Breakthrough Session Momentum Month Personal Journey Bitcoin Education Other If other, please specify: Primary Goals or Focus Areas Briefly describe your primary goals or areas of focus for coaching (e.g., career, personal development, health, financial education, etc.) What would you like from your coach during your sessions? Select all that apply Gaining clarity of issues Understanding what is important /what motivates me Exploring and understanding what is holding me back Gaining an insight into who I am, my strengths, capabilities and potential Providing encouragement and support Helping define goals Helping to identify action and next steps Challenging you with difficult questions Providing honest and direct feedback Making you accountable for your goals Not Sure Additional Information Is there anything else I should know to better support you on your journey? Thank you for reaching out!Your information has been received, and we’re excited to start this journey with you. We’ll be in touch soon to discuss your goals and next steps.
