New Client Intake Form — LifeTurner Coaching

✦Contact Information

Full name *

Preferred name

Email address *

Phone number

Preferred contact method

How did you hear about us?

1Personal & Lifestyle Snapshot

Age range

Living situation

Work schedule

Describe your daily routine

Current lifestyle priorities (choose up to 3)

What feels most out of balance right now?

2Stress & Emotional Patterns

How often do you feel overwhelmed?

What situations trigger stress for you?

How do you typically respond to stress? (select all that apply)

What emotions do you experience most often?

How comfortable are you expressing emotions?

What helps you calm down or reset?

What drains your emotional energy the fastest?

3Identity & Self-Image

How would you describe your current self-image?

What identity do you feel you are living from today?

What identity do you WANT to live from?

What internal narratives shape your choices?

What beliefs limit your progress?

What strengths define you?

How often do you visualize your desired future self?

What would change if your self-image improved?

4Physical & Lifestyle Habits

Describe your sleep patterns

Describe your eating patterns

Describe your movement or activity level

How often do you feel physically energized?

What habits support your physical wellbeing?

What habits weaken your physical wellbeing?

What physical changes would improve your daily life?

5Social & Relational Wellness

How connected do you feel to others?

Who supports you emotionally?

How comfortable are you asking for help?

How would you describe your communication style?

What relationships feel nourishing?

What relationships feel draining?

What social changes would improve your wellbeing?

6Environmental Wellness

Describe your home environment

Describe your work environment

How safe do you feel in your daily spaces?

How organized are your surroundings?

How often do you spend time in nature?

What environmental changes would help you feel better?

7Purpose, Meaning & Motivation

What gives your life meaning?

What goals matter most to you right now?

What motivates you?

What drains your motivation?

What future do you envision for yourself?

What feels missing from your life?

What would make your life feel more aligned?

8Behavioral Barriers & Habit Loops

What habits feel hard to break?

What habits feel easy to maintain?

What patterns repeat in your life?

What gets in the way of your progress?

What do you avoid, and why?

What do you procrastinate on?

What would help you stay consistent?

9Readiness for Change

How ready are you to make changes?

What support do you need to succeed?

What pace of change feels right for you?

What accountability style works best for you?

What fears come up when you think about changing?

What excites you about changing?

10Coaching Preferences

Preferred coaching style

Preferred communication

Preferred session frequency

What do you want MOST from coaching?

What do you want LEAST from coaching?

How do you define success in this program?

✦Consent & Agreement

LifeTurner Coaching provides non-clinical, wellness-based support focused on lifestyle, behavior, identity, and whole-person alignment. This intake form does not collect medical history, diagnose conditions, or provide clinical treatment. All information shared is protected under our privacy standards and used solely to support your wellness journey.

I understand that LifeTurner Coaching is a non-clinical wellness program and not a substitute for professional medical or mental health care. *