Teen Client Profile

Coaching Agreement

Please review the Family Coaching Agreement prior to completing this form. A copy of the agreement will be sent to you by email, and an abbreviated version requiring your signature will be sent prior to our first session.

Teen's Information

Teen's Name

First Name

Last Name

Teen's Birthdate

YYYY

Teen's Email Address

Use your email address if your child does not have their own.

Teen's Cell Number

(###)

###

####

Preferred Phone Number

(###)

###

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Current School

Current Grade

Social Media Profiles

Please provide any social media services with your child's username.

Parents' Information

Mother's Name

Father's Name

Preferred/Billing Email Address

Please remember to use this address when making payment.

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Preferred Phone

(###)

###

####

Father's Preferred Phone

(###)

###

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Home/Secondary Phone

(###)

###

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Family Information

Sibling Names/Ages

Secondary Parents

(if applicable)

Names

Preferred Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Relationship Situation

Confirmations

EFL Coaching Mailing List

In order to keep you informed about your coaching program, you must agree to have your preferred email address added to my clients-only mailing list. Your information will never be sold, rented, or in any way used by third parties.

I agree to be placed on the EFL Coaching, LLC Mailing List

This ADHD Life Mailing List

You may wish to subscribe to my general mailing list. Simply choose 'Yes' below and your preferred email address will be added to the list.

Yes

Coaching Agreement

I have reviewed and agree to the Coaching Agreement. I understand a copy will be sent to me upon payment and I agree to sign the signature form during our Intake Session.

I have reviewed and agree to the Coaching Agreement.