Adult Client Intake Form
Background Information & Goals
Areas you want to address in counseling/coaching*
Which of the following apply ?*
Names / Ages of any Children
What motivated you to look for a counselor/coach?*
What do you wish to change/achieve from therapy?*
Ever been to counseling? If so, how was it?*
What are your strengths?*
Which of the these apply?*
Please elaborate on these wellness items ...
Have you experienced ...?*
Please elaborate on these experiences...
Is there anything else you would like to add?