Sara Miller of True North coaching physicians and executives.

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New Client Intake Form

Please complete the form below and it will be automatically emailed to us. Or, if you prefer, click here for the new client form in pdf so that you can view and print this form to email or fax back to us.


Name:
Address:
City:
State:
Zip:
Work Phone:
Home Phone:
Mobile Phone:
Fax:
Email:

If your life were exactly as you wanted it, how would it look?

What is not working in your life?

What do you want from this coaching experience?

What would you like from me in terms of the coaching process?

How do you want me to be as your coach?

What goals would you like to achieve in six months?

What goals would you like to achieve in two years?

What goals would you like to achieve in five years?

What else would you like to share or request that will help begin the coaching process?

Which phone number do you prefer for contact or messages?

Which day(s) and time(s) are you typically available for coaching? (Please include your time zone)