CLIENT QUESTIONNAIRE

  • Tell me about you!

  • THE INITIAL INTAKE FOCUS FORM

    By completing this Focus portion of the form, you will be highlighting key pieces of information in preparation for your first consultation. The process of putting it in writing facilitates clarity and better structures your scheduled time. I, too, can become better oriented to your situation as we start our working relationship. If time permits, it is helpful to complete and submit this form to me prior to our first meeting.
  • e.g working relationship, personal relationship, medical condition, workload, career direction, time management, etc.
  • If "Other" please describe in the space available
  • e.g. time, activities, money
  • 9. On a scale of 1 to 10, with “10” being the “BEST” and “1” being the “WORST”,
    answer the following questions and check the number for your response, e.g. 7: