top of page

LifeHouse Intake Form

(Prophetic Life Coaching Client Onboarding Form)

Please fill out the following form.

Date of birth
Month
Day
Year

For Your Safety & Our Boundaries

Mental Health Awareness: LifeHouse Prophetic Life Coaching provides spiritual support and practical guidance, but is not therapy, counseling, or treatment for mental health conditions, substance dependence, or psychiatric disorders. To ensure we can serve you safely and effectively within our scope, please answer the following:

Are you currently under the care of a mental health professional (Therapist, Counselor, psychiatrist, psychologist, etc.) or have you been in the past?
Yes
No
Are you currently taking any prescribed medications (especially those that may impact your mental clarity, mood, or perception) or regularly using non-prescribed drugs, alcohol, or other substances?
Yes
No
Do you struggle with substance dependence or abuse?
Yes
No
Prefer not to answer

Why We Ask & How It Helps:

  • We ask this to honor your safety and the integrity of our coaching relationship. Understanding this background helps us:

  • Ensure coaching is the right support for you at this time.

  • Actively partner with any therapeutic care you are receiving.

  • Avoid potential conflicts between practices or insights and medication/substances.

  • Pray effectively and discern wisely.

  • Coaching works best when clients have mental clarity and stability. Your honesty allows us to create a supportive and effective environment.


    All information shared here remains strictly confidential per our policy stated below.

Please READ and check all boxes below:

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

For Daily Motivation

© 2023 by Eric T. Williams. All rights reserved.

bottom of page