INTAKE FORM | Marion Miller Coach

Intake Assessment Form
Please answer the questions honestly, giving as much information about yourself as feels right. This information is treated as strictly confidential and you will be emailed a follow up within a few days to make a booking if you haven't already. Thank you, Marion Miller.

Full name including any pronouns

Address

Phone

How did you find out about me?

What beliefs get in the way of you creating the kind of life or work path you desire?

What are the main themes you want to focus on while working together? List at least three things.

Can you tell me about your past experience with personal or professional coaching, counselling or mindfulness and what approaches you're keen to explore with me?

Have you suffered from a mental health condition or ever recieved a mental illlness diagnosis or medication for mental health? If so can you provide a little context on how it has impacted your growth.

What are you hoping to get from working with me? Try to be specific and list at least 3 clear goals.

Tell me about all your greatest achievements, motivations, strengths and talents. Is there anything you want to tell me that will be helpful to know?

If you awoke tomorrow and you were living your version of the dream life. What is the first five things you would notice?

Thanks for submitting. We'll be in touch shortly.

Intake Assessment Form Please answer the questions honestly, giving as much information about yourself as feels right. This information is treated as strictly confidential and you will be emailed a follow up within a few days to make a booking if you haven't already. Thank you, Marion Miller.

Intake Assessment Form
Please answer the questions honestly, giving as much information about yourself as feels right. This information is treated as strictly confidential and you will be emailed a follow up within a few days to make a booking if you haven't already. Thank you, Marion Miller.