Client Intake Form — Keith Peters Career Coaching

About You

Full Name

Email Address Where should I send your Career Snapshot?

Your Current Situation

Current Role & Setting Job title, organization type, how long you've been there, and your caseload or primary focus if relevant.

Licensure Status Where are you in the licensing process? Include state, credential, and supervision hours if in progress.

The Real Stuff

What's Not Working Be honest. What's making you consider a change? Pay, burnout, environment, leadership, the work itself — all of it.

Ideal Next Role It's okay if it's fuzzy. Describe a feeling, a type of work, a setting — whatever you can name. You don't need a job title.

Biggest Obstacle What do you think is standing between you and that next role right now?

You'll receive your personalized Career Snapshot within 3–5 business days (or same-day if you choose the paid option below).

Your intake is in.

I've got your answers. Now choose how you want to move forward.

Same-Day

$47

Career Snapshot Today

I'll review your answers and send you a personalized Career Snapshot — plus book a 20-minute intro call — before end of business day.

Free

I'll Wait

No problem — I'll get to your intake within 3–5 business days and send your Career Snapshot when it's ready. No charge.

You're on the list

Either way, I read every intake personally. — Keith