Let’s work together.

Please complete this Coaching Intake Form 24 Hours Before Our First Session.

Complete all pertinent questions, if you are single; disregard the couple’s related questions.

Name

First Name

Last Name

Date

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of Years with Current Partner

Children Names and Ages

Previous Marriage(s) & Lengths of Marriage(s)

Profession(s)

Check Any Issues That Apply to You or Your Partner

Additional Information

Kendall would like each of you attending the session to send a summary to give background information and your wishes for the session.

Support Team

Please provide a list of therapists/coaches you have seen, starting with current therapists, and include any from the past. For each, please let us know whether Kendall has permission to contact him or her if need be.

Let’s work together.

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