New Stress Management Coaching Client Intake Form [35 questions] | Practice

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New Stress Management Coaching Client Intake Form

Are you looking for a comprehensive and reliable way to get to know your new stress management coaching clients? With the New Stress Management Coaching Client Intake Form, you can easily and quickly collect important information about your clients and their goals.

This form is designed to provide you with all the information you need to create a personalized plan to help your clients reduce their stress levels and achieve their goals. It covers vital topics, such as the client's background, goals, challenges they are facing, timeframe for achieving their goals, and more.

By gathering this information upfront, you can save time and get to know your clients in depth, assessing their needs and challenges. This helps you create a tailored plan that will empower your clients to reach their goals and reduce their stress levels.

The New Stress Management Coaching Client Intake Form is easy to use and is designed to streamline your intake process and help you provide the best service to your clients. With this form, you can easily and quickly get to know your clients and start helping them on their journey to success.

New Stress Management Coaching Client Intake Form

What is your job title?
If you're married or in a relationship, what is your spouse or significant other's name?
If you have kid's, what are you kid's name(s)?
What's your date of birth?
What is your phone number?
What is your preferred method of communication?
What specific changes would you like to make?
Out of all the changes you'd like to make, which ones feel the most important/urgent?
Have you tried anything in the past (or recently) to change your stress, burnout, habits, or mindsets? If so, what?
Which of those things worked well for you, and why? (Even just a little bit, and even if you might not be doing them right now.)
Which of those things didn’t work well for you, and why not?
Until now, what has blocked you or held you back from changing these things?
Given all the demands of your life, what is your typical stress level on an average day? (1 = no stress , 5 = extreme stress)
Are you regularly active in sports and/or exercise?
If so, approximately how many hours per week?
What types of sports and / or exercise do you typically do?
Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school,
home repairs, moving around at work, gardening)
Right now, how much do the people and things around you support your stress, burnout, and behavior change?
Have you have been diagnosed (currently or in the past) with any significant medical condition(s) and/or injuries?
Right now, do you have any specific health concerns, such as illnesses, pain, and / or injuries?
In an average week, how many hours do you spend working?
In an average week, how many hours do you spend taking care of others?
In an average week, how many hours do you spend doing unpaid work like education, school work, or unpaid housework or errands?
In an average week, how many hours do you spend traveling and/or commuting?
In an average week, how many hours do you spend volunteering?
On a scale of 1-10, how do you feel about your schedule, time use, and overall busy-ness? (1 = my life is panicked and insane, 5 = my life is perfectly calm and relaxed)
On average, how many hours per night do you sleep?
How do you normally cope with your stress?
How READY are you to change your behaviors and habits? (1= not at all, 5 = completely)
How WILLING are you to change your behaviors and habits? (1= not at all, 5 = completely)
How ABLE are you to change your behaviors and habits? (1= not at all, 5 = completely)
What do you expect from me as your coach?
What are you prepared to do to work towards your goals?
Please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking burnout and stress management consultation.
Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.
Please check this box to indicate agreement with the above statement.

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