Client Intake & Coaching Agreement

Choose and pay for your service plan, then fill out this mandatory form before our first meeting.

Thank you for filling out this form thoroughly before our first meeting so we can start our coaching partnership with clear and personalized information for you.

Today's Date

Name

Address

Email & Phone

Birthday

Month

Day

Year

Full address

Gender

Male

Female

Other

Occupation and place of employment (if applicable)

Marital status and individuals living in your household

Lifestyle and Wellness

Are there any medical conditions, surgeries or health concerns that you would like to share?

List any medications or supplements you are currently taking

Do you have specific dietary or physical restrictions?

Where would you numerically rank your current stress levels at WORK - from 1 (little to no active stress) to 5 (consistently high levels of stress)

Where would you numerically rank your current stress levels at HOME - from 1 (little to no active stress) to 5 (consistently high levels of stress)

What are the specific stressors or challenges in your life that you would like to work on?

Have you worked with a wellness coach, life coach or therapist in the past? If yes, please describe time frame

Current Routines and Habits

Describe your typical daily routine with work hours and leisure activities

Describe your typical nightly routine and average sleep hours.

Describe your weekly physical activity (type, frequency, duration of exercise)

Describe your typical eating habits, including meals and snacks.

List any specific dietary goals or concerns you would like to work on?

Who/what is your primary support system? How do you prefer to receive support from others?

Do you have a specific interest or openness to addressing spiritual or mindfulness practices as part of your wellness journey?

Yes

Maybe

What are you hoping to gain from this wellness coaching experience?

How much time are you realistically willing to commit to wellness activities each week? Please list any scheduling constraints or considerations

Please list any additional information or context you believe is important for me to know as your wellness coach

Wellness Coaching Agreement

Confidentiality & Liability: All personal information shared during coaching is kept private and will not be disclosed unless required by law or with your written permission. Coaching is not a substitute for licensed medical, psychological, or legal advice. By signing, you release Rachel Frost and Know Better Do Better Coaching from any liability for decisions, actions, or outcomes resulting from coaching.

Cancellations and Rescheduling: I value both your time and mine. Please notify me at least 24 hours in advance if you need to cancel or reschedule your coaching session. Cancellations or

rescheduling requests with less than 24 hours’ notice, or missed appointments without notice, will be charged the full coaching session fee.

By signing, I state I have read and agree to the following:

Coaching is not medical care, therapy, or a substitute for licensed treatment.
I am responsible for my own choices, actions, and outcomes
I will consult my physician, mental health provider, or other qualified professional before making significant health or lifestyle changes.
My participation is voluntary, and I may stop at any time. I also understand and agree with the cancellation and rescheduling policy.

Signature

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Client Intake & Coaching Agreement

Lifestyle and Wellness

Current Routines and Habits

Wellness Coaching Agreement

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