Client Entry Form – The Tao of Staas Life Coaching

This form is to help you assess where you are in your life as well as to clarify your intentions and goals for the coaching series.

Today's Date*
MM slash DD slash YYYY
Your Name*
First Last
Country*
City*
Your Phone*
If outside of the USA, please indicate your country and city codes
Your Email*

The best email to reach you
Rate the following aspects of your life from 0 to 10 (10 being perfect) as you feel today
Physical (body & health)*
0 1 2 3 4 5 6 7 8 9 10
Relationships (Romantic)*
0 1 2 3 4 5 6 7 8 9 10
Friends*
0 1 2 3 4 5 6 7 8 9 10
Financial*
0 1 2 3 4 5 6 7 8 9 10
Fun/Hobbies/Interests*
0 1 2 3 4 5 6 7 8 9 10
Spiritual*
0 1 2 3 4 5 6 7 8 9 10
Family*
0 1 2 3 4 5 6 7 8 9 10
Career/Work/Business*
0 1 2 3 4 5 6 7 8 9 10
Mindset/Mental State/Attitude*
0 1 2 3 4 5 6 7 8 9 10
Home & Environment*
0 1 2 3 4 5 6 7 8 9 10
Service/Charity/Community/Contribution*
0 1 2 3 4 5 6 7 8 9 10
Write 3 main outcomes you would like to achieve with coaching
Outcome #1*
Outcome #2*
Outcome #3*
Pick the most important outcome of the 3 above, set a timer for 5 mins, and write in a free-flow fashion what is preventing you from having it already today. Do not edit yourself, just a stream of consciousness.*
Human Design
I ask for your birth time, date, and location to offer you a free Human Design chart (a tool for making choices in perfect harmony with who you are), which can benefit you in our coaching sessions as well as offer you a wealth of practical information for life. Providing this information is optional. If you do not feel like sharing it, you can omit it.
Date of Birth:
MM slash DD slash YYYY
Time of Birth

: Hours

Minutes

AM/PM
City (and State) of Birth
The state is applicable only for clients born in the USA; otherwise, the city name is sufficient.
Country of Birth

Rate the following aspects of your life from 0 to 10 (10 being perfect) as you feel today

Write 3 main outcomes you would like to achieve with coaching

Human Design