CitizenSteward International
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 TAKE THE NEXT STEP IN YOUR JOURNEY

Client Intake Form

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Name *
Name
Phone
Phone
Instructions: Please number your response as such – (1) Goal (2) Goal (3) Goal (4) Goal (5) Goal – so that I can more easily distinguish between them.
Session Preferences *
Session Preferences
Instructions: Our coaching sessions will focus on your needs and follow your agenda. Below are some approaches we can take in our discussions – please rate them according to your preferences.
I need help understanding what is important to me.
I need someone to challenge me with difficult questions.
I need help gaining clarity around certain issues.
I need someone to provide honest and direct feedback.
I need help identifying actions and next steps.
I need someone to provide encouragement and support.
I need help holding myself accountable to my goals.
I need help gaining insight into my strengths and innate potential.
I need help overcoming particular obstacle and hurdles.