COACHING
INTAKE FORM

Welcome aboard the environmental sustainability boat! I'm super stoked to have you on this eco-adventure with me. 🌱⛵

First, I want you to know that I take your trust very seriously. What an honor for me to guide you through this vital work. We are changing culture and healing the planet together 🙌

Big thanks for taking the time to fill out this form. Your decision to do this demonstrates a genuine commitment to positively impacting the world around you, and I truly appreciate your dedication. You can share as much or as little as you want – I'm all ears and totally cool with whatever feels right for you.

I'm all about keeping it light, so have some fun with your responses! Express your wildest eco-dreams and even those eco-worries. This is YOUR space to let it all out.

Remember, honesty is the name of the game here. No judgments, no worries. This form is for you to grow and for me to support you better. This is not a scorecard! Many of the questions are there to help us pinpoint opportunities.

A gentle little reminder: any unsustainable habits you might have aren't your fault at all. We're all swimming in the same sea of conditioning by the system we and our parents grew up in. That’s why we’re here, right? Recognizing and breaking those patterns together!

I split the form into sections to complete at your own pace. Give yourself 30 minutes or so to finish them. But don’t rush!

Alright, let's do this! Get ready to bring goodness into your life and make some real change happen!

With gratitude and high-fives,

Tareq🌎💚

Basics

Intake Form - Basics

Name

First Name

Last Name

Pronouns

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Preferred Communication Channel?

Phone

Text

What's your occupation? Do you work from home?

Special Needs or Physical Limitation?

Home & Lifestyle

Intake Form - Home

Describe your living situation

Do you live in a house, apartment, or somewhere else?

Who all's part of your green team at home?

Family members, roommates, animals

Any cool outdoor spaces or gardens around your place that we can make even more eco-friendly?

Are there any specific challenges or limitations related to sustainability at home or in family life?

How do you get around?

Car

Public Transit

Bike

Good ol Feet

Other

How often do you go out of town? When you do so, how do you get there

Break it down by distance from home vs method of transportation

Priorities

Intake Form - Priorities

What got you interested in environmental sustainability coaching?

What are your primary goals and motivations for signing up for this coaching?

Are there any eco-friendly habits or lifestyle changes you've been itching to try out?

Boasting Time. I'd love to hear about any of your core values that can factor into our work here

Are there any specific environmental issues that tug at your heart a little extra?

Pick up to three!

Water/ocean pollution

Plastic and trash all over the freaking planet

Climate change

Trees and forests

Healthy food systems

Animal & wildlife welfare

Environmental justice (I know this is a broad one)

Other Issues

Water

Energy

Food

Waste

Intake Form - Waste

Tell us how you handle your waste

What services are available to you? Are you a recycling champion? Or is it kinda loose?

Do you dabble in the magic of composting your food scraps?

Do you do it yourself or is it picked up by a service?

How do you feel about the amount of landfill garbage that you produce?

Any particular waste-reduction challenge you'd like us to tackle together?

Do you try to avoid single-use plastic as you fulfill your needs?

Again, no judgment. Just need to know where we're starting 💚

Engagement

Expectations

Phew, you did it! I know that was a lot of contemplating and getting real with yourself. Good job for taking this seriously and making the most of your investment.

I honor and respect that you’ve shared some intimate and personal details. It’s a vulnerable thing! I want you to know that I see that and look forward to turning this stuff into gold. I got you!

The more you put in this process, the more you and Mother Earth will get out.

I can't wait to get started on your journey.

Tareq 🌍💚

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Trillium Sustainability LLC
Duawamish Land (Seattle, WA)
hello@trillium.eco

COACHINGINTAKE FORM