NEW CLIENT INTAKE & DISCOVERY FORM
Welcome to Nautijae Freedom Coaching
This form is an opportunity to begin telling me about yourself, your life, what brings you here, and what you want to explore.
There are no right or wrong answers. You do not need to have everything figured out before we begin. Answer as many questions as you wish to.
This intake is intended to help establish the focus of our coaching relationship. It is not a psychological, psychiatric, medical, or clinical assessment.
1. ABOUT YOU
Full Legal Name:
Preferred Name:
Email Address:
Phone Number:
Current Location (City/Country/Time Zone):
How did you hear about Nautijae Freedom Coaching?
Referral
Website
Social media
Search engine
Personal connection
Other: ______________________________
2. WHY ARE YOU HERE?
What brings you to NFC at this point in your life?
If you had to describe where you are in your life right now in three words, what would they be?
What are you hoping will change, shift, become clearer, or become possible through this work?
What would make this work genuinely worthwhile for you?
Is there a particular situation, relationship, transition, decision, pattern, or question you want to explore?
3. WHERE YOU ARE NOW
What feels most alive or important in your life right now?
What feels stuck, repetitive, unresolved, or out of alignment?
What are you tolerating that you no longer want to tolerate?
What are you longing for that you haven’t yet created?
What do you feel you already know but haven’t fully acted on?
4. YOUR PATTERNS
Are there patterns in your life that you keep finding yourself repeating?
What tends to trigger you, derail you, or pull you away from yourself?
Where do you tend to abandon yourself, overextend yourself, shrink yourself, or ignore your own needs?
What beliefs about yourself or the world are you currently questioning?
What part of yourself do you feel you have lost, suppressed, abandoned, or outgrown?
5. YOUR STRENGTHS
What are you exceptionally good at?
What qualities do other people tend to recognize in you?
What gives you energy?
What makes you feel most like yourself?
What parts of yourself do you want to reclaim, strengthen, or expand?
6. YOUR LIFE STORY
What major experiences have shaped who you are today?
Are there particular life experiences, relationships, environments, losses, transitions, or turning points that feel important to the work you want to do?
What chapter of your life do you feel you are currently in?
What chapter are you ready to leave?
What chapter are you ready to begin?
7. WHAT YOU WANT
What do you want more of in your life?
What do you want less of?
What are you ready to stop carrying?
What are you ready to release?
What are you ready to reclaim?
What are you ready to create?
8. WHAT WOULD YOU LIKE SUPPORT WITH?
Select everything that feels relevant.
Clarity
Emotional freedom
Self-understanding
Breaking repetitive patterns
Reconnecting with myself
Processing difficult life experiences
Life transition
Relationships
Boundaries
Confidence
Self-trust
Identity
Purpose
Direction
Personal transformation
Spiritual exploration
Energetic exploration
Reclaiming lost parts of myself
Creating a new chapter of my life
Other: ______________________________
9. HOW YOU LIKE TO BE SUPPORTED
What kind of support feels most useful to you?
Direct and challenging
Gentle and exploratory
A combination of both
Intuitive guidance
Practical perspective
Accountability
Asking questions that make me think differently
Helping me see patterns I cannot see myself
I’m not sure yet
How open are you to exploring perspectives or approaches outside conventional coaching?
Very open
Open
Curious but cautious
Unsure
I prefer primarily conventional coaching approaches
Are there particular approaches you would like included or avoided?
10. BOUNDARIES & SUPPORT
What do you need from a practitioner in order to feel safe enough to do meaningful work?
Are there boundaries, sensitivities, or topics you want me to know about before we begin?
Is there anything you do not want to explore at this time?
Is there anything else you believe I should know about you?
11. YOUR FUTURE
If nothing fundamentally changed, what would your life look like five years from now?
If you were completely free to design your life, what would it look like?
Who would you be if you were no longer organizing your life around fear, conditioning, other people’s expectations, or old versions of yourself?
What would you do if you trusted yourself completely?
12. THE GREAT QUESTION
Imagine that our work together has been profoundly successful.
Who are you now?
What is different about your life?
What have you finally become free from?
What have you reclaimed?
What have you created?
13. FINAL WORD
Is there anything you have been waiting for someone to ask you that I haven’t asked?
CLIENT ACKNOWLEDGMENT
Please confirm:
I have answered these questions voluntarily and to the best of my ability.
I understand that this intake form is intended to help establish the focus of coaching and is not a psychological, psychiatric, medical, or clinical assessment.
I understand that Nautijae Freedom Coaching is an independent, unregulated coaching and personal-development practice.
I have read and agree to the separate Client Privacy, Confidentiality & Release of Liability Agreement.
Full Name:
Date:
Submit Intake
CLIENT PRIVACY, CONFIDENTIALITY & RELEASE OF LIABILITY AGREEMENT
Practitioner: Jae Honeybae
Client: ____________________________________________
Date: ______________________________________________
Please read this agreement carefully before beginning your coaching relationship with Jae.
1. WHAT NAUTIJAE FREEDOM COACHING IS
NFC is an independent, unregulated coaching and personal-development practice.
The work is expansive and integrative and may draw upon intuitive guidance, transformational coaching, reflective inquiry, somatic awareness, visualization, mindfulness, energetic practices, personal-development exercises, experiential exploration, and other integrative approaches.
The purpose of the work is to support personal exploration, self-awareness, emotional freedom, integration, personal responsibility, life direction, self-discovery, and personal transformation.
2. WHAT NFC IS NOT
NFC is not:
psychotherapy
psychological assessment
psychological treatment
psychiatric care
medical care
healthcare
diagnosis or treatment of mental disorders
diagnosis or treatment of physical disorders
addiction treatment
crisis intervention
emergency mental-health care
medical treatment
a substitute for a physician
a substitute for a psychologist
a substitute for a psychiatrist
a substitute for a registered clinical counsellor
a substitute for a psychotherapist
a substitute for any other regulated healthcare or mental-health professional
The practitioner is not a regulated healthcare or mental-health professional and does not represent herself as one.
No diagnosis of a mental, emotional, psychological, psychiatric, or physical condition will be provided.
Freedom Coaching does not claim to diagnose, cure, prevent, or medically treat disease, mental-health conditions, psychological conditions, psychiatric conditions, or physical conditions.
If you require medical, psychiatric, psychological, or other regulated healthcare services, you are responsible for obtaining those services from an appropriately qualified professional.
3. THE NATURE OF THE WORK
NFC may involve exploring your:
life experiences
emotions
relationships
beliefs
identity
values
patterns
decisions
boundaries
purpose
goals
personal history
sense of self
future direction
Some exercises may involve discussing difficult or emotionally significant experiences.
Some practices may involve:
body awareness
visualization
movement
breath
writing exerscises
intuitive exploration
energetic practices
reflective exercises
You remain the authority over your own experience.
You may decline an exercise, establish a boundary, pause a conversation, ask questions, or discontinue participation at any time.
4. NO GUARANTEE OF RESULTS
No particular result, healing, transformation, experience, or outcome is guaranteed.
NFC does not guarantee:
emotional healing
resolution of trauma
improved mental health
improved physical health
changes in relationships
financial results
spiritual experiences
energetic experiences
personal transformation
achievement of specific goals
resolution of past experiences
or any other particular outcome
Results vary from person to person and depend upon many factors, including circumstances and choices outside the practitioner’s control.
5. CLIENT RESPONSIBILITY
I understand that I remain responsible for my own:
decisions
actions
health
wellbeing
relationships
choices
interpretations
and use of information arising from the coaching process
I understand that personal-development work may bring up difficult thoughts, emotions, memories, insights, or experiences.
I agree to communicate with the practitioner if I become uncomfortable, overwhelmed, confused, or unable to participate.
I understand that I am responsible for obtaining appropriate medical, psychological, psychiatric, or other professional support when needed.
6. PRIVACY & CONFIDENTIALITY
Information shared with NFC will be treated as private and confidential, subject to applicable law and the limitations described in this agreement.
Confidential information may include:
personal history
family information
relationship information
emotional experiences
personal goals
beliefs
values
written reflections
coaching conversations
communications
personal circumstances
exercises
other information voluntarily provided during the coaching relationship
Your information will not intentionally be disclosed to another person without your permission except where disclosure is required or permitted by applicable law or under the circumstances described in this agreement.
7. LIMITS OF CONFIDENTIALITY
Confidentiality cannot be guaranteed absolutely.
Information may be disclosed where required or permitted by applicable law, including circumstances involving:
a serious and foreseeable risk of significant harm to you or another person
a court order
circumstances involving the protection of a child or vulnerable person where reporting is legally required
your authorization to disclose information
You would be informed before confidential information is disclosed if necessary by law.
8. ELECTRONIC COMMUNICATION
NFC may communicate with you by:
email
telephone
text message
video conferencing
or other mutually agreed methods
Electronic communication carries inherent privacy and security risks.
Although reasonable precautions will be taken, absolute security cannot be guaranteed.
I understand and accept these limitations when choosing to communicate electronically.
9. CLIENT INFORMATION & RECORDS
NFC may maintain reasonable records necessary to provide and administer the service.
These may include:
contact information
appointment information
administrative records
coaching notes
client agreements
intake information
exercises or materials relevant to the coaching relationship
Reasonable measures will be taken to protect personal information from unauthorized access, use, or disclosure.
Information will be retained and disposed of in accordance with applicable legal requirements and reasonable business practices.
10. USE OF CLIENT STORIES, TESTIMONIALS & INFORMATION
Your personal information will not knowingly be sold or provided to third parties for advertising purposes.
Your identity, photograph, personal story, testimonial, or identifiable experience will not be publicly used for promotional purposes without your separate permission.
If an anonymized example is used for educational purposes, reasonable steps will be taken to remove identifying information.
11. ASSUMPTION OF RISK
I understand that transformational coaching and personal-development work involve personal exploration.
I understand that this process may sometimes produce unexpected:
emotions
memories
insights
discomfort
challenges
questions
changes in perspective
I voluntarily choose to participate.
I accept responsibility for my participation and the decisions I make during and following the coaching process.
I understand that I may stop, decline, or modify an exercise at any time.
12. RELEASE OF LIABILITY
I understand that participation in Nautijae Freedom Coaching is voluntary.
I understand that no particular outcome has been promised or guaranteed.
To the fullest extent permitted by applicable law, I voluntarily assume responsibility for my participation in the services and for decisions I make during or following the coaching relationship.
To the extent permitted by applicable law, I release and hold harmless the practitioner, Jae Honeybae, and Nautijae Freedom Coaching from claims arising from my voluntary participation in the services, except for liability that cannot legally be excluded, restricted, or waived.
Nothing in this agreement is intended to exclude, restrict, or waive any legal right or liability that cannot lawfully be excluded, restricted, or waived.
13. PROFESSIONAL BOUNDARIES
The relationship between the practitioner and client is professional.
I understand that NFC does not create:
a medical relationship
a psychiatric relationship
a psychotherapeutic relationship
a physician-patient relationship
The practitioner may decline requests or activities that fall outside the scope of NFC.
The practitioner may recommend that I seek another professional when my needs fall outside the scope of coaching.
14. EMERGENCIES
NFC is not an emergency or crisis-response service.
If I am experiencing an immediate medical or mental-health emergency, or believe that I or another person is in immediate danger, I understand that I must seek appropriate emergency or crisis assistance rather than relying on NFC.
15. VOLUNTARY PARTICIPATION
I understand that participation in NFC is voluntary.
I may ask questions about the work.
I may establish boundaries.
I may decline an exercise.
I may pause a session.
I may discontinue the coaching relationship.
I understand that the practitioner may also determine that the coaching relationship is not appropriate for my circumstances or needs and may recommend another form of professional support.
16. CLIENT CONSENT & ACKNOWLEDGMENT
By submitting this agreement, I confirm that:
I have read and understood this entire agreement.
I understand that NFC is an independent, unregulated coaching and personal-development practice.
I understand that the practitioner is not a regulated healthcare or mental-health professional.
I understand that NFC does not provide psychotherapy, psychological treatment, medical care, psychiatric care, diagnosis, or emergency mental-health services.
I understand the nature and scope of the coaching services.
I understand the limits of confidentiality.
I understand the privacy risks associated with electronic communication.
I understand that participation is voluntary.
I understand that I remain responsible for my own health, wellbeing, decisions, and actions.
I understand that no particular outcome has been promised or guaranteed.
I have had an opportunity to ask questions about this agreement.
I voluntarily consent to participate in NFC under these terms.
17. ELECTRONIC SIGNATURE
By typing my full legal name below, I confirm that I have read, understood, and voluntarily agree to this Client Privacy, Confidentiality & Release of Liability Agreement.
Full Legal Name:
Electronic Signature:
Date:
Client Email:
CLIENT POLICIES, PAYMENT, CANCELLATION & RESCHEDULING AGREEMENT
Practitioner: Jae Honeybae
Client: __________________________________________
Date: ____________________________________________
Please read this policy carefully before booking or participating in a coaching session with Nautijae Freedom Coaching.
1. PAYMENT POLICY
Payment is due in full no later than 24 hours before the scheduled coaching session.
An appointment is considered confirmed once payment has been received.
If payment has not been received at least 24 hours before the scheduled session, NFC reserves the right to release the appointment time and make it available to another client.
For prepaid packages, the applicable session or session credit is considered committed to the scheduled appointment and remains subject to the cancellation and rescheduling policy below.
2. CANCELLATION POLICY
Your appointment time is reserved specifically for you.
Because appointments are scheduled in advance and generally cannot be offered to another client at short notice, no less than 24 hours’ notice is required for cancellation.
Cancellation with 24+ Hours’ Notice
If you cancel your appointment with 24 hours or more notice, you may:
reschedule your session, subject to availability; or
request a refund where applicable under the terms of your purchase.
Your paid session will not be forfeited solely because you cancelled with sufficient notice.
3. RESCHEDULING POLICY
No less than 24 hours’ notice is required to reschedule an appointment.
If you request to reschedule with 24 hours or more notice, your session may be moved to another available appointment time.
Rescheduling is subject to availability.
Repeated rescheduling may be addressed on an individual basis.
4. LATE CANCELLATION
A cancellation made less than 24 hours before the scheduled appointment is considered a late cancellation.
A late cancellation will result in loss of the paid session.
No refund, credit, or replacement session will be provided.
For prepaid packages, the applicable session credit will be considered used.
5. NO-SHOW POLICY
Failure to attend a scheduled session without providing notice is considered a no-show.
A no-show results in loss of the paid session.
No refund, credit, or replacement session will be provided.
For prepaid packages, the applicable session credit will be considered used.
6. LATE ARRIVAL
Your session begins at the scheduled appointment time.
If you arrive late, the session will generally still end at the originally scheduled time.
The missed portion of the session will not ordinarily be added to the end of the appointment.
If circumstances allow, the practitioner may choose to extend the session, but this is not guaranteed.
7. EXCEPTIONAL CIRCUMSTANCES
NFC recognizes that genuine emergencies and circumstances beyond a client’s reasonable control can occur.
At the practitioner’s discretion, an exception to this policy may be granted in exceptional circumstances.
An exception is not guaranteed and does not establish a precedent for future cancellations.
8. PRACTITIONER CANCELLATION
If practitioner needs to cancel or reschedule an appointment, the client will be given as much notice as reasonably possible.
The client will be offered the option to:
reschedule the session; or
receive a refund for the affected session, where applicable.
A practitioner cancellation will not result in forfeiture of the client’s paid session.
9. PACKAGES & SESSION CREDITS
Where coaching is purchased as a package, individual sessions within that package remain subject to this policy.
A session that is cancelled or rescheduled with less than 24 hours’ notice, or missed without notice, will be deducted from the package.
Unused package sessions are subject to expiration 13 weeks from date of purchase.
10. REFUNDS
The four-pack sesssion package is non-refundable.
Cancellation with appropriate notice does not automatically create a refund entitlement but maintains the session credit.
11. CLIENT RESPONSIBILITY
Clients are responsible for:
keeping track of their appointment times;
providing accurate contact information;
ensuring payment is made on time;
providing at least 24 hours’ notice when cancelling or rescheduling;
attending sessions at the scheduled time.
If you are unsure about an appointment, please contact NFC as soon as possible.
12. AGREEMENT
By booking an appointment with Nautijae Freedom Coaching, I acknowledge and agree that:
I have read and understand the Client Policies, Payment, Cancellation & Rescheduling Agreement.
I understand that payment is due in full no later than 24 hours before my scheduled session.
I understand that at least 24 hours’ notice is required for cancellation or rescheduling.
I understand that cancellation or rescheduling with less than 24 hours’ notice results in loss of my paid session.
I understand that a no-show results in loss of my paid session.
I understand that late arrival does not ordinarily extend the scheduled session.
I understand that exceptions for genuine emergencies or exceptional circumstances are at the practitioner’s discretion.
I understand that package sessions are subject to these same policies and are non-refundable.
CLIENT ACKNOWLEDGMENT
Full Legal Name:
Electronic Signature:
Date:
I AGREE TO THE NAUTIJAE FREEDOM COACHING CLIENT POLICIES