New Clients

Step 1: Book your session

Step 2: Fill out the intake form

Please fill out and submit this form before your first session, as it will help Senée provide you with the most effective and personalized support. Your contact information is essential for ensuring smooth communication regarding your sessions, and the earlier you can send it in, the more deeply we can understand and cater to your needs. We truly appreciate your cooperation in this process.

Name *

First

Last

Phone Number *

Enter your best contact number where you can receive calls & texts (ex. 555-436-2222).

Email *

Mailing Address *

Street address with Apt./Suite number.

City/State/Zip Code *

Gender *

• Male
• Female

referred on: by

Age *

Birthday *

Month/Day/Year (ex. 10/19/1914)

Occupation *

Relationship Status *Single, never married (dating)Single, never married (looking)Single, never married (not dating)Single, never married (in a relationship)Divorced (dating)Divorced (looking)Divorced (in a relationship)Divorced (not dating)Separated (not entertaining anyone else)Separated (dating someone else)Married (happily)Married (unhappily)Married (dating outside the marriage)

Choose ONE option that most closely fits your situation.

Religious affiliation *Not religiousSpiritualChristian (Catholic)Christian (Protestant)JewishRaised religious, not practicingOther

Choose the closest fit.

Do you have children? *

• No
• Age: 15-18
• Age: Newborn-4
• Age: 19-22
• Age: 5-11
• Adult children
• Age: 12-14

What areas do you want to work on?

• Career
• Education
• Romantic relationship
• Marriage
• Family dynamics
• Friendships
• Addiction recovery
• Grief
• Self-esteem
• Becoming more social IRL
• Finding my purpose
• Becoming the best version of myself
• Being happier
• Strengthen my spiritual connection
• Other

Check all that apply.

Specific issue(s) you want to work on:

List all that apply.

Have you experienced any of the following recently? *Anger (displayed through violence toward self)Anger (displayed through violence toward others)Anger (displayed through words/non-violent displays)DepressionSuicidal thoughtsSuicidal attemptsLonelinessLow self-worthGriefNone of these

Select the most severe.

Are you currently taking psychiatric medication prescribed to you by a healthcare provider?

• Yes
• No
• I have in the past

Who referred you?

First

Last

Leave blank if you were not referred by someone.

How did you find out about us? *Social Media (Facebook)Social Media (YouTube)Social Media (Twitter/X)Social Media (Pinterest)Spotify podcastEmailWord of mouth/ReferralOther

Select the one options that most applies.

What transformation are you hoping to achieve from therapeutic coaching or Christian counseling? *

• Sign-up to our newsletter?

Submit

Step 3: eSign and return the Coaching Agreement

Please take a moment to download, read, and eSign the Therapeutic Coaching/Christian Counseling Agreement. Please follow the instructions to return it to Senée before your scheduled session. We are genuinely excited to support you on this meaningful journey and want to ensure everything is in place for your coaching process. It’s important to emphasize that we can only accommodate clients who have completed their Agreements. This step not only prepares you for a rewarding coaching experience but also demonstrates Senée’s dedication to fostering a professional and supportive therapeutic coaching relationship. We truly appreciate your cooperation in making this possible.

Download the Therapeutic Coaching/Christian Counseling Agreement

✓ read & eSign

✓ return before first session

Download now