SACRED FEMININE AWAKENING MENTORSHIP PATH INTAKE FORM Today's Date * MM DD YYYY Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Date of Birth MM DD YYYY Occupation Emergency Contact Name * First Name Last Name Phone * (###) ### #### Relationship to Client * Relationship Status * Single Dating Married/Long Term Partner Divorced Widowed How do you perceive this aspect of your life right now? * What significance does this mentorship hold for you at this moment in your life? What is drawing you toward it right now? * What insights do you have about your life’s purpose? * VISION- "Your Guiding Star": What is your heart and soul truly longing for? What are your deepest goals and aspirations? Consider this as your inner compass leading you forward. The more authentic and heartfelt your response, the more powerful it becomes. Concentrate on your core desires instead of specific goals (like losing weight or finding a new job.) If this isn't fully clear to you yet, give it time and allow it to unfold naturally. * WINS & ACCOMPLISHMENTS: What meaningful achievements have you made on your journey? Reflect on a personal or professional win that has brought you closer to your purpose—whether it’s a shift in mindset, a career or business milestone, or newfound freedom in time or finances. What accomplishment stands out as truly significant to you? STRENGTHS: What personal and professional qualities do you possess that empower you to succeed? Reflect on the areas of your life that feel most vibrant and fulfilling at this moment. VALUES: Your values are the core principles that resonate most deeply with you and are non-negotiable in your life. Reflect on what is truly important and meaningful to you as you navigate your life’s journey. Try to name three core values. * Beyond yourself, who are the most important people in your life, and what do they say about you? GOALS: Identify three meaningful goals you would like to focus on during our time together. * Which of these reflects your current experience? Check all that apply. * You aren’t progressing toward your goals as quickly as you’d like. Everything feels full of possibilities, yet making them happen is challenging. You find yourself stuck in unhelpful patterns of thinking or behavior (such as imposter syndrome, self-sabotage, procrastination.) You’re ready to evolve but unsure how to start. You struggle with focus or decision-making. You need to improve your time or energy management. CURRENT CHALLENGES: What immediate challenges are you navigating that need your attention? Where are the highest points of stress or urgency in your life right now? * BLOCKS AND WEAKNESSES: What internal barriers or weaknesses do you notice that hinder your progress? This is an opportunity for honest self-reflection and deeper self-awareness. * In what ways might uncertainty, anxiety, or fear be holding you back? If fear were not a factor, what would you choose to pursue? * What patterns of thought or behavior might be hindering your progress? Identify a specific pattern and provide an example. * How do you handle yourself when you experience failure? What could you do to recover more gracefully? * What additional support would help you stay accountable? * During our sessions, what can I do or say to help you stay focused and move forward with purpose? * Are you currently taking any medications, supplements, or other substances? * Are you experiencing any mental health challenges, such as anxiety, panic attacks, or depression? * Is there anything else you would like me to know about you and your life? What else could help me support you better. * AGREEMENT/REMINDERS: * I understand that all information I entered in this form will be considered strictly confidential. The data gathered from this form will only be used as a basis for the type of coaching the client will need. I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client. I agree THANK YOU!
