Spiritual Coaching & Powerful Conscious Breathing with Hunter Flournoy
828-450-8800 info@hunterflournoy.com
www.hunterflournoy.com

Intake Form for Spiritual Coaching & Powerful Conscious Breathing

Thank you so much for committing to your own spiritual freedom. The twenty questions below will help you clarify your desires, feelings, challenges, and goals for our work together, and how our work fits into your over-all happiness. If you are a continuing client, these questions will also help us evaluate our progress together, and identify the next steps in your journey. I look forward to our session!

 •	Name:
 •	Email:
 •	Phone:
Mailing Address:
Occupation:

 1.	What desires, concerns, or intentions would you like to work on in our coaching together? Please list the top three.

 2.	What's working in these areas?

 3.	What's not working in these areas?

 4.	What do you feel in these areas, and what would you like to feel instead?

 5.	When have you been most satisfied, happy, or fulfilled? How did it feel?

 6.	When have you been most dissatisfied or unhappy? How did it feel?

 7.	List three things you are tolerating right now in your life.

 8.	List three things you are doing without right now in your life.

 9.	Which of the following BEST describes the coach you want?
 a.a.	Someone to apprentice to
 a.b.	Someone to help me clarify desires,  visions, goals, or methods
 a.c.	Someone to help me ask good questions
 a.d.	Someone to give clear compassionate reflections
 a.e.	Someone to teach me information and skills
 a.f.	Someone to hold me accountable
 a.g.	Someone to encourage me

 10.	Which of the following LEAST describes the coach you want?
 a.a.	Someone to apprentice to
 a.b.	Someone to help me clarify desires  visions goals, or methods
 a.c.	Someone to help me ask good questions
 a.d.	Someone to give clear compassionate reflections
 a.e.	Someone to teach me information and skills
 a.f.	Someone to hold me accountable
 a.g.	Someone to encourage me

 11.	How do you like to be supported when hitting challenges in your personal growth?

 12.	How satisfied, happy, or fulfilled are you right now?
   
	(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 13.	How fulfilled are you around health & wellness?

 		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally
	
 14.	How fulfilled are you around finances & abundance?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 15.	How fulfilled are you around friendship & community?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 16.	How fulfilled are you around intimate relationship?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 17.	How fulfilled are you around vocation & career?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 18.	How fulfilled are you around creativity & education?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 19.	How fulfilled are you around fun & celebration?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

 20.	How fulfilled are you around spirituality & growth?

		(1) Not at all   (2) Not Very   (3) Neutral   (4) Mostly   (5) Totally

Extra Credit! Please email a headshot or selfie of yourself.