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Life Coach/Strategy Intake Form

Please provide the following information. Information you provide is confidentiality just as

Life Coaching or Mentoring.

May we email you?
May we leave message?
Marital Staus
Referred by: (check any that apply)

Life Strategy Agreement

Our sessions are conducted over then phone and virtual (Skype, zoom, Facetime, etc.).

The cell number is (843)437-9111.

Missing or rescheduling sessions is strongly discouraged. If an unforeseen event does require
you to reschedule, I must be notified 24 hours prior to the scheduled session. Please
remember that not completing, or partially completing your assignments is not a reason to


If assignments are not complete, it is very important that we work together during
your scheduled session to strategize, overcome obstacles, and establish next steps.
If notification is not given 24 hours prior to the scheduled session time, the session will be
considered missed and thereby forfeited.

Life Coaching Disclaimer of Liability: Client hereby employs as Life Coach for the purpose
of supporting the Client with respect to Client’s self-awareness, vision and goals, and
strategic plans, has experience in such matters and agrees to render such coaching


Once you have completed this form, please email it to me at or
bring it to the initial session. Any questions, be sure to contact me.

Thanks for submitting this form. We will be in touch soon.

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