
360 LC Peer Mentor Coaching Orientation
Part 2: Client Questionnaire
Welcome to your transformative journey! Complete this questionnaire to begin your peer life coaching program.
Please ensure payment is completed in the application section before proceeding.
Section 1: The Past – Shadows, History, and Foundations
This section helps you explore formative life experiences, past beliefs, and unresolved emotions
that may still impact your life today.

Section 1: The Past – Shadows, History, and Foundations
Welcome to Your Coaching Journey
As your Life Coach, our role is to act as a catalyst—guiding you from where you are now to where you aspire to be.
We focus on the present and future while helping you recognize any lingering energy from the past that may still be affecting you.
⚠️ Please note: If you are currently dealing with unresolved trauma, we will kindly refer you to a licensed therapist,
as that level of support is outside our coaching scope.
About This Form
This intake form is your first step in the coaching process. It’s designed to help both you and your coach gain clarity about your
current mindset, goals, and desires. The questions are reflective and may require some thoughtful consideration.
You only need to complete the sections that are relevant to you. If a section doesn’t apply, simply write “N/A.”
- Answer each question as completely and honestly as possible.
- If a question doesn’t apply to you, write “N/A.”
- Use this opportunity to reflect on your journey, organize your thoughts, and define your goals.
- Once completed, proceed to checkout to finalize your booking.