Life Consulting Client Form
New Client Information Have you had sessions in any of the following fields before: Life Coaching, Counseling, Therapy, Inner Healing, SOZO, etc? If you have, how regularly did it play a part in your life? Was it helpful? If so, what breakthroughs did you receive? Was it a positive or negative experience and why?
Please briefly (within a few sentences) describe three difficult life experiences that have significantly impacted you. For each experience, please list a few things that brought you joy, peace, or love during that time.
Please briefly elaborate on what you are trying to overcome.
Please check any of the major life experiences that you are wanting to discuss.
Do you have a stable community you are able to process with?
What are your hopes for meeting with me?
I understand that life consulting is not designed to be a form or treatment for a mental health illness that impacts my ability to live life in a way that I or others find acceptable.
Have you ever experienced a mental health challenge that has impacted your ability to live life in a way that feels acceptable to you or others (e.g., bipolar disorder, schizophrenia, PTSD, anxiety, or depression)?
If yes, please describe how this has affected your daily life.
Have you ever been under the care of a mental health professional for this challenge (e.g., inpatient care, outpatient team, psychologist, psychiatrist)? If so, please describe the treatment you received.
Are you currently on any medication to help with a mental health difficulty? How long have you been taking this medication?
Please describe how you feel this medication affects you. If you are currently taking medication, please let us know if you plan to stop taking it during the course of our meetings together.
Have you ever engaged in any self harm behaviors (i.e. cutting, burning, biting, hitting, starvation, binging and purging)?
Have you ever experienced thoughts of wanting to end your life?
Have you ever attempted to take your own life?
Are you currently experiencing thoughts of wanting to end your life?
Emergency contact Information (someone who lives near you) - please include their name, relationship to you, and phone number:
Submit Form
