Find a Life Coach New Client Form Client InformationName*FirstLastHome or Work PhoneCell Phone*AddressCityStateZipAge*Email address*Referred byWork InformationOccupationYour responsibilitiesAdditional InformationHow would you describe yourself?Describe your relationship.Have you ever had counseling?YesNoHow did it help?Physical illnesses or injury (describe)?Email Address*Are you taking any medication (describe)?How would you like your life to be different in each of the following areas?WorkRelationshipRelationshipHealthSpiritualFirst Session Guarantee If for any reason you are dissatisfied with your initial session let me know and there will be no charge.Informed Consent Agreement I understand that coaching, or counseling, sessions or workshops are for educational purposes and are not psychotherapy or a substitute for psychotherapy. Coaching differs from psychotherapy in that therapy typically focuses on illness or the effects of trauma while coaching focuses on the enhancement of achievement and fulfillment in a person. I also understand that this work will likely bring about deep emotional and mental change. In consideration for participation in coaching, or counseling, sessions I assume full responsibility for myself (and/or for my children) during any work – and for all the results of this work – and hereby release all Life Coach Austin Coaches and any other involved parties from any and all liability and from any failure due to negligence. I agree that I have read this entire statement. I also agree to provide 24 hours notice if canceling or rescheduling a session.Signature*Signed*I agreeBy checking this box I agree to the above mentioned consent details.Date*Send