Individualized coaching intake form

The purpose of this form is to ask preliminary questions to determine the level of coaching we would need to provide. Questions regarding mental health are strictly asked to ensure that we are coaching within the state of Illinois guidelines. SIX 24, LLC is not a mental health licensed practice. 

Would you consider yourself mentally healthy at this time in your life?
Are you interested in moving forward toward the future or are you interested in coaching to explore some past issues in order to move forward?
If you have a diagnosed mental illness or disorder, Are youcurrently under the care of a mental health professional?
Do you want coaching as a space to vent and heal or a space to take action and move toward the future?

© 2020 SIX 24, LLC Professional Certified Life Coaching

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