Booking & Contact

Client Intake Form

Personal Information

Full Name(*)

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Date of Birth(*)

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Gender(*)

Male

Female

Prefer not to say

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Email(*)

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Phone(*)

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Preferred Contact Method(*)

Phone

Other

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Other

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Service Selection

Which type of support are you seeking?(*)

Coaching

Mentoring

Energy Healing

Not sure — open to guidance

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Please email me if you’re unsure which service to ask for. I’ll be glad to assist.

What brings you here today?

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Have you worked with a coach, mentor, or healer before? (*)

Yes

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If yes, what was your experience like?(*)

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What are your main goals or intentions for our work together?

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What area(s) of your life are you seeking support in?

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What feels most challenging for you right now?

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What would success look like after our sessions?

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How ready are you to commit to change (1–10)?

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In what area do you feel you need guidance/mentorship?

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What specific skills, knowledge, or experiences are you hoping to gain?

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Who inspires you as a mentor figure and why?

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What challenges are you facing that you’d like mentorship on?

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Have you received energy healing before? (*)

Yes

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Are there specific areas of discomfort (physical, emotional, spiritual)?

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Do you currently have any health conditions or take medications?

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What is your intention for receiving healing?

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Preferred Session Format(*)

In-Person

Online

Either

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Availability / Best Days & Times(*)

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Emergency Contact (optional)

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Every journey begins with a single step—yours starts with an Insight Session. Take a moment to reach out, ask what you need to know, and explore if this coaching journey is meant for you.

No matter where you are in the world, we can connect. Sessions are available via Zoom, WhatsApp, Google Meet, or your preferred platform—in English or Farsi.

Whether you’re ready to begin or just curious, I welcome you to get in touch. This is your space. Your time. Your haven.
Reach out to havenofcoaching@gmail.com to receive the intake questions and coachability form. From there, we’ll move forward together, one intentional step at a time

Life isn't about finding yourself life is about creating yourself.

Booking & Contact

Client Intake Form

Personal Information

Service Selection

Life isn't about finding yourself
life is about creating yourself.