Client Intake Form

SereenSolutions is happy to welcome you as a new client and excited to help you achieve your personal goals. Please complete the following information and click Submit below after Personal Profile page.

First name

Last name

Address

Birthday

Month

Day

Year

Phone

Spouses Name (If Applicable)

Start Date

Month

Day

Year

Type of Service

Time to Emerge

Embrace Your Transformation

Nurture Connections

Disclaimer: Client is aware that the coaching relationship does not represent psychological counseling or any kind of therapy.

Disclaimer: Client is aware that coaching results can vary and are not guaranteed as they are entering into coaching with the understanding that the Client is responsible for their own decisions and results.

Disclaimer: Client also agrees to hold the Coach free from all liability for any actions or results for adverse situations created as a direct or indirect result of advice given by the Coach.

No Show/Cancellation Policy: Client to contact the Coach at scheduled time. If Client fails to make appointment, Client is still responsible for coaching fees, unless 24 hour notice is given to reschedule. The Coach will make every effort to reschedule.

Client's Signature

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Date

Month

Day

Year

Client Intake Form

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