Metamorphosis Coaching Wellness Intake Form

Client's Name *

Date *

Please take a few moments to answer the following questions regarding your wellness goals. Your responses will help me better understand where you currently stand regarding your mental, emotional, financial, physical, social, and spiritual well-being. This will enable me to provide more personalized guidance during our coaching sessions. Your answers will be kept confidential.

Mental Well-being:

a. On a scale of 1-10, how would you rate your overall mental well-being? *

b. What are the main stressors or challenges you currently face in your life? *

c. Are you experiencing any specific mental health concerns or symptoms (e.g., anxiety, depression, lack of focus)? If yes, please provide details. *

Emotional Well-being:

a. On a scale of 1-10, how would you rate your overall emotional well-being? *

b. What are the emotions that you frequently experience? (e.g., joy, sadness, anger, anxiety) *

c. Do you want to address unresolved emotional issues or traumas during our coaching sessions? *

Financial Well-being:

a. On a scale of 1-10, how would you rate your overall financial well-being? *

b. What are your financial goals and aspirations? *

c. Are there any specific financial challenges or concerns you would like assistance with? *

Physical Well-being:

a. On a scale of 1-10, how would you rate your overall physical well-being? *

b. How frequently do you engage in physical exercise or activity? *

c. Do you have any specific health or fitness goals? If yes, please provide details. *

Social Well-being:

a. On a scale of 1-10, how would you rate your overall social well-being? *

b. How connected do you feel to your friends, family, and community? *

c. Are there any social challenges or issues you would like support with? *

Spiritual Well-being:

a. On a scale of 1-10, how would you rate your overall spiritual well-being? *

b. What role does spirituality or a sense of purpose play in your life? *

c. Do you want to explore spiritual or existential questions during our coaching sessions? *

Overall Wellness:

a. How important is overall wellness to you on a scale of 1-10? *

b. What are your top priorities for enhancing your overall wellness? *

c. Do you want to discuss other areas or aspects of your well-being during our coaching sessions? *

Please feel free to provide any additional information or comments that you believe would be helpful for me to know.

Thank you for taking the time to complete this questionnaire. Your responses will enable me to tailor our coaching sessions to your specific needs. I look forward to working with you and helping you achieve your wellness goals.

Be well,

Dawn Bowens

CEO Metamorphosis Coaching

Contact me at, www.mindingmypassionbusiness.com, [email protected], or (301)471-3832