New Coaching Client Intake Form

This form is for those working with one of our Market Refined Media & Publishing coaches. Whether you are an author or dreamer (or both!), we look forward to reading through the information you share with us here.

“Storytellers instill hope again and again and again.” – Walt Disney

Please complete this form in its entirety. An incomplete form will delay the discovery process. Thank you!

By submitting this form, you are granting our agency permission to retain your personal information for the purpose of contacting you and/or providing services to you. View our Privacy Policy here.

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website URL

If you have a personal, ministry, or business website, share the link here.

Section 1: LIFE

On a scale of 1-10, rate each area of your life (spiritual, emotional, physical, financial, relational, etc.) and the reason for this score.

Spiritual: rate this area of your life (1-10)(Required)

Please enter a number from 1 to 10.

Spiritual: what's the reason for this score?

Emotional: rate this area of your life (1-10)(Required)

Please enter a number from 1 to 10.

Emotional: what's the reason for this score?

Physical: rate this area of your life (1-10)(Required)

Please enter a number from 1 to 10.

Physical: what's the reason for this score?

Financial: rate this area of your life (1-10)(Required)

Please enter a number from 1 to 10.

Financial: what's the reason for this score?

Relational: rate this area of your life (1-10)(Required)

Please enter a number from 1 to 10.

Relational: what's the reason for this score?

What are you most excited to share? Most afraid of that might get in the way of your storytelling?(Required)

Write down the names of 2-3 friends who can encourage you as you put yourself out there as a storyteller (your HYPE friends).(Required)

Text them and ask them for encouragement!

Section 2: CREATE

What kind of storytelling do you currently create or dream of creating?(Required)

For instance: oral, visual, written, and/or digital — spoken word, music, written, dancing, acting, producing, photography, drawing, painting, etc.

Are you currently working on any creative arts project that you need help with, or would like Renee to read, listen to, watch, or engage with?

If you are unable to share the details here, please email them to us at least one week before your scheduled session.

Section 3: BUSINESS

Do you already have a business set up for your storytelling, products, and/or services? If so, are you currently satisfied with it?(Required)

If you do not already have a business, what would you like your business to accomplish? What is your BIG DREAM for your business?

Section 4: SPIRITUAL

What story are you telling yourself about your life and how you live it?(Required)

What story are you telling yourself about your worth?(Required)

How can we help you listen well for God in this season of your life?(Required)

Section 5: DREAMS

What are your big dreams?(Required)

Example: go on a dream vacation; publish a book…

What are your fun dreams?(Required)

Example: ride in a hot air balloon; learn how to paint…

What are your physical dreams?(Required)

Example: lose weight; beat an illness; go skydiving…

What are your financial dreams?(Required)

Example: become debt free; give significantly to a church, ministry, or charity…

What are your emotional dreams?(Required)

Example: overcome fear, anxiety and depression; forgive and reconcile a broken relationship…

What are your spiritual dreams?(Required)

Example: go on a ministry conference or retreat; travel to Israel; learn more about the Father heart of God…

What are your legacy dreams?(Required)

Example: pass on a ministry you started at church or online; save an inheritance for your children…