Name

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City

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IPHI Student/Graduate? (Yes / No) If yes, which program(s) have you completed or are enrolled in?

What would you most like to focus on in this session?

(e.g., client case support, confidence in communication, professional boundaries, business strategy, niche clarity, emotional regulation, etc.) Write a few lines or bullet points.

If applicable, please briefly describe any client case or challenge you’d like Mar’s support with: (No identifying details needed. Just a short overview.)

What is one outcome or feeling you’d love to walk away from this session with? (e.g., clarity, confidence, next steps, relief, new tools...)

Is there anything you’ve tried already related to this issue?

Do you have any tools, approaches, or practices that are currently working well for you?

Are there any past experiences with coaching that have been especially helpful—or unhelpful?

How would you prefer your session tone to be? (select one or more)

Direct & Focused
Gentle & Encouraging
A mix of both
Surprise me—I’m open!

Please share any additional information you would like us to know.

Confirmation

I understand that this session is for professional mentorship and/or personal development, not therapy, diagnosis, or treatment.

Disclaimer & Waiver Statement

Disclaimer: I understand that coaching sessions with Mar De Carlo are intended for educational and professional development purposes only. These sessions are not a substitute for licensed medical, psychological, or therapeutic care, nor do they include the diagnosis or treatment of medical or psychological conditions. I take full responsibility for my own decisions, actions, and outcomes as a result of this coaching session. Waiver: By signing below, I waive any liability from Mar De Carlo and her affiliates, and I agree not to hold her responsible for any outcomes resulting from the advice, tools, or strategies shared during our session.

Confidentiality Agreement

I understand that all personal and professional information shared during this coaching session is confidential and will not be shared without my written consent, unless required by law. I also agree to uphold the same confidentiality for any materials or proprietary strategies shared by Mar De Carlo during our session.

Acknowledgment Checkbox

I have read and agree to the disclaimer, waiver, and confidentiality agreement above.

Signature

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IPHI Coaching Mentorship with Mar De Carlo Intake Form