Client Intake – Stress Less: The R.E.A.L. Way Coaching

Welcome. Let’s get to know you.

This short intake helps Coach Samantha Campbell prepare for your time together so your sessions can focus on what matters most to you. It takes about 5–7 minutes.

Your answers are private and shared only with your coach. Share as much or as little as feels comfortable. Coaching is educational support, not therapy or medical care.

First name

Last name

Email

Mobile phone

Age range

18–24

25–34

35–44

45–54

55–64

65+

How do you prefer to meet for sessions?

Microsoft Teams video

Phone call

Either is fine

What brings you to coaching right now?

Overall, how would you rate your stress level lately?

1–2 Calm

3–4 Manageable

5–6 Noticeable

7–8 High

9–10 Overwhelming

Three months from now, what would you love to be different?

Have you worked with a coach before?

Yes

No

Are you currently working with a therapist, counselor, or doctor for stress, anxiety, or depression?

Yes

No

Prefer not to say

Stress Less: The R.E.A.L. Way is faith-integrated. How would you like faith to be part of your coaching?

Please weave faith in

A little, when it fits

I prefer to keep it non-religious

Emergency contact (name and phone)

How did you hear about us?

Anything else you would like Samantha to know? (optional)

I understand coaching is educational support and not a substitute for therapy, medical care, or emergency services, and I agree to be contacted about my coaching by email or phone. Privacy policy