Client Intake Form - Martindale Coaching

Date / Time

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Email current achieving

What goals do you have for these coaching sessions?

What are some challenges you face in achieving your goals?

What changes do you want to make in your current situation?

Have you worked with a coach before?

No
Yes

How often are you available for coaching sessions?

Once Per Week
Once Per Month
Twice Per Month
Other

I'm interested in...

Private Coaching
Keynote Events
Group/Team Coaching
Custom Packages

Please provide any additional information that you would like me to know...

Services

To get started, replace this text with your own.

The services to be provided by the coach to the client are in-person or tele-coaching, as jointly designed by the coach and client. The tuition for the agreed upon program should be paid in full prior to first session.

Rescheduling

Rescheduling/cancellation of an appointment must be made 24 hours in advance. Please make every effort to do so. The first time a session is missed, I will not charge you for it. The second time and every subsequent time, I will charge you in full for the session.

Limit of Liability

You expressly understand and agree that martindale coaching shall not be liable to you for:

Any direct, indirect, incidental, special consequential or exemplary damages which may be incurred by you, however caused and under any theory of liability. This shall include, but not be limited to, any personal injury, emotional distress, loss of goodwill, or other intangible loss;
Some jurisdictions and states preclude limit of liability clauses. In the event damages are assessed, the limit of liability for Martindale Coaching shall not exceed the total amount of the agreed upon contract - to the licensee or third party.
As I coach I will not tell you what to do, and you, as the client, are always empowered to choose and are held responsible for your actions. The client assumes all responsibility for any action taken on account of a coaching session as well as all outcomes and results.