Alignment Circle Intake | Heart To Heart Coach

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Welcome — I’m looking forward to working together. Please complete this intake at least 24 hours before your session so I can prepare for you.

Basic Information

First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

About You

What are your favorite colors?*

What are your favorite places or environments?*

What type of vacation do you most enjoy?*

Do you have any fears or phobias you would like me to know about?*

Intentions & Vision

What are your three biggest goals in life right now?*

What would you most like to receive from being part of The Alignment Circle?*

If you could change one thing about your life today, what would it be?*

Where You Are Right Now

Please rate each area from 1–10 (1 = lowest / most challenged, 10 = highest / most satisfied)

Life balance*

Emotional well-being*

Confidence / self-trust*

Stress level*

Relationships*

Career / purpose satisfaction*

Connection to intuition / inner guidance*

How ready do you feel to create change or transformation in your life right now?*

What do you feel has held you back most? (check all that apply)*

Fear or self-doubt

Past experiences

Lack of clarity

Time constraints

Financial stress

Relationships

Health or energy

Other

How do you learn best?*

Visual

Listening

Hands-on / experiential

Writing / journaling

Discussion / conversation

How did you hear about Enlightened Pathways?*

If Social media/Referral/Event please list

Is there anything else you would like me to know before we begin?

I understand that The Alignment Circle is a personal growth and coaching experience and is not a substitute for medical or mental health treatment.

Signature - Signature (type your full name)*

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Enlightened Pathway Healing Center

Heart-to-Heart Coaching

864 559-0249

melissa@ephcenter.com

Enlightened Pathways Healing Center

Where Wholeness IS Remembered

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