Client's General Information Form

Please fill out this information sheet completely and return it to me as soon as possible, preferably via email. For those unfamiliar with the process: first, save this document on your computer; then go in and open it and fill in the data; then save again and close. Next, open your email and attach that document to an email addressed to Sandee@LivingWatersCoach.com. Thanks, and I am looking forward to getting to know you!

Today’s Date:

Name:

Address:

Contact Numbers:

Birth date: Age: Spiritual Birth Date: Anniversary:

Spouse Name:

Marriage situation:

Children/Grand-children living at home: Children/Grand-children living outside the home:

Name Age Name Age

Please describe the sibling connection. For example, are these all your birth children; or are they foster, adopted or step -children; and how many years you have been sharing the raising of the children.

Describe briefly, in outline form, any past or current life-changing transitions that you feel might affect your dreams, desires or goals you have for this time in your life.

Describe briefly, your current situation that you feel might affect your dreams, desires or goals you have for this time in your life (this may or may not be a life-changing transition as mentioned above).

What is your occupation? Please describe your duties and how you feel and/or what you think about your job:

What are your dreams, desires or goals for your life; short-term or long-term?

What are your goals and objectives to realize your dreams, desires or goals?

What three dreams, desires or goals brought you to coaching?

Is there anything else you’d care to share with me?