Individual Coaching Form

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Individual Coaching Intake Form

First name*

Last name

Email*

Phone*

What time zone do you live in?*

Have you ever been diagnosed with a mental health issue/disorder? If yes, please indicate the diagnosis*

How long have you been in recovery?*

Have you been through a formal disclosure process with a therapist, coach, mentor, etc?*

How would you know that the help you're receiving is working? Identify 3 outcomes you hope to see from coaching -*

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