Please take the time to fill this out if you are a new client. Thank you! Introductory Session: New Client Intake Form Your Full Name * Date * Your Phone Number * Email Address * How Did You Hear About The Mighty Child? * Website/URL Simple Contact Box-please use this field to communicate questions, comments, other. Complete any/ all sections of this form to help me prepare for your session. I Am Optimistic 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? I Am Satisfied With My Life 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? I Am Satisfied With My Health 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? I Am Satisfied With My Financial Situation 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? I Am Satisfied With My Social Life 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? I Feel Good About My Personal Relationships 1 2 3 4 5 I Am Motivated For Change (s) To Occur In My Life 1 2 3 4 5 On a Scale from 1 to 5 with 1 being the lowest and 5 the highest, how would you rate yourself? What Are Your Three Most Significant Disappointments What Are Your Three Most Significant Accomplishments Describe Your Top Three Strengths Describe Your Weakness (s) I Am Happiest When I... I Feel My Lowest When I... Describe Any Goal (s) or Desire (s) That You have Yet To Fulfill What Has Hindered You From Achieving Your Goals or Desires? Current Conflict That I Would Like Resolved: Individual or Family I Am Requesting Support With the Following If you are human, leave this field blank.