Life Coaching Enrollment Form

Please complete the form below to complete your enrollment.

First Name

Last Name

Date of Birth

Are you under the service of a life coach, mental health therapist or psychiatrist? *

Yes

Are you experincing suicidal/homicidal thoughts?

Yes

What areas of life coaching are you interested in working on?

Personal Development

Effective Communication

Self Awareness

Emotional Wellbeing

Lifestyle Strategies

Goal Setting

Relationship Building

Confidence Building

Career Development

Identifying Strengths

Mindset Strengthening

Are you willing to commit to weekly or bi-weekly sessions?

What are your 3 strongest strengths?

What do you hope to gain from life coaching?

Personal growth

Life and work balance

Ability to manage behaviors

Become open to lifestyle change

Ability to communicate my feelings

Ability to overcome obstacles

Develop a self-care regimen

Ability to make positive decisions

Accountability

Is there a specific goal you want to acheive from life coaching?

To maintain high respect for all individuals, please advise how you identify?

I declare that the info I’ve provided is accurate & complete. I understand that all payments are nonrefundable. I am aware that service must be paid in full at the time of scheduling.

Thank you for choosing

Luxe Wellness, LLC

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Email: Hello@luxewellness.org

Phone: 786-475-1199

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