New Client Intake Form
Personal Information:
Goals and Objectives:
Previous Coaching Experience:
Preferences and Expectations:
Psychological and Emotional History:
Lifestyle and Habits:
Fitness Goals:
Social Support and Relationships:
Additional Information:
By submitting this form, you acknowledge that all information provided will be kept confidential between you, the client and Chronic & Iconic Coaching, in accordance with professional coaching ethics and standards, HIPAA regulations and the Privacy Act of 1974.