Client Assessment Form

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Personal Information

Full Name *

Email Address *

Gender (Optional)

Phone Number (Optional)

Employment Information

Occupation *

Annual Income *

Employer Name *

Source of Funds *

Current Status:

What are your primary goals or objectives in seeking consulting services? Please list them. *

Are there any strategies or actions you've already taken to address your goals? If yes, please describe. *

Have you previously worked with a consultant or coach for personal or professional development? *

How do you envision achieving these goals in the next 6-12 months? *

What do you hope to achieve through this consulting relationship? *

Are you currently implementing any self-improvement strategies or methodologies in your personal or professional life? *

Please discuss as openly as possible the areas in which you are seeking improvement. Whether it pertains to personal growth, professional development, leadership enhancement, or business advancement, your candid insights will allow me to tailor my approach to best support your journey. *

I believe that understanding your unique challenges and aspirations is essential to your growth. In this section, I invite you to share openly the specific areas where you’re seeking improvement. Whether you’re focused on personal growth, professional development, leadership enhancement, or business advancement, your honest input will help me tailor our approach to best support your journey. Your success is my priority, and I’m committed to providing the customized guidance you need to reach your goals.

As we move forward, it's important for us to ensure that the services I provide are not only aligned with your goals but also fit within your financial planning. Could you share with me what your monthly budget for consulting looks like? This will help me tailor my services to offer the best value while staying within the parameters you’re comfortable with. My aim is to make sure we’re both aligned, so we can focus on achieving the results you’re looking for. *

“As we plan our work together, I want to make sure my services fit well with your goals and your budget. Could you let me know what your monthly budget for consulting looks like? This way, I can tailor what I offer to match your needs and ensure we’re both on the same page as we move forward.”

Declarations and Authorizations

Consent for Data Collection and Processing

I consent to the collection and processing of my personal information.

Accuracy of Information

I confirm that the information provided is accurate to the best of my knowledge.

Client Agreement

I have read and agree to the client agreement.

This is only to establish a plan to work together and not a contract.

Signature and Date

Client's Signature

Clear Signature

Date of Submission