Form cover
Page 1 of 5

New Client Intake & Coaching Agreement

Welcome! đź’›

Please answer the questions below to the best of your ability and capacity. Some are required, while many are optional. I invite you to take a little time to read through and reflect on the questions, even if you choose not to write a response to those that are optional.

I also know that not everyone’s parts enjoy filling out forms (some may have very strong feelings about them!), so please don’t feel any pressure to have the “right” answer or to share more than feels comfortable. Whatever you choose to offer will simply help me get to know you and arrive to our first session with a little more context about you and your inner world.

First Name

Last Name

Pronouns

What do you like to be called?

Phone Number

Email Address

A Bit About You ❤️

Your birth year

Where in the world are you located?

What time zone are you in?

How did you find your way to my practice?

What Brings You Here?

What’s calling you toward this kind of support? What are you hoping to shift, learn, explore, and/or gain through our work together?

What is your experience with parts work / Internal Family Systems (IFS), if any?

How often do you imagine wanting to meet for sessions?*

A
B
C
D
E

A Little About Your Support Experience

Are you currently working with a therapist or counselor?

A
B
C

Have you worked with a coach before?

A
B
C

Is there anything about your current or past experiences with therapy, coaching, or other forms of support that you’d like me to know?