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Your intake form has been submitted. A copy is on its way to your email. Tom will review everything before your first session and will be in touch soon.

— Tom Faust  |  Legacy by Design

Legacy by Design • Pearl Lane, LLC

New Client Intake Form

12-Week Coaching Program — Please complete this before your Week 1 session.

There are no right answers here. This isn't a test — it's a starting point. Be honest rather than impressive. The man who writes raw, uncomfortable truth on these pages will get far more out of the next 12 weeks than the one who wrote something that sounded good. If you completed the Next Chapter Clarity Guide, use your reflections there to inform your answers. If you didn't, no problem — just answer from where you actually are right now. That's all that's needed.

01
The Basics
Contact information and a quick snapshot of where you are in life right now.
Check all that apply.
02
Why Now
What brought you here, and what's actually at stake.
Not the polished version — the real trigger. What happened, or what kept happening, that finally got you here?
Not tasks or to-do items. What feels unresolved at a deeper level? What part of your life looks fine on the outside but doesn't sit right on the inside?
Be honest. Don't soften it.
03
The Experience You're Bringing
Your past is raw material, not baggage. Let's take stock of it before we build anything.
Don't write a resume. Just give me a sense of where you've been, what you've built, and the kind of work that has defined most of your adult life.
Success that no longer energizes you is often the first sign you're ready for the next chapter.
The stuff you rarely mention but know was real. Could be professional, personal, or both.
Think about what people come to you for, or what you know that took decades to figure out.
04
The Direction You're Pointing
You don't need a finished plan. Just honest language about what you want to build.
It's okay if this is incomplete or uncertain. What are you moving toward? What do you want your days, your work, and your contribution to look and feel like?
On your family, your community, the people you serve, a field you care about, or a body of work you want to leave behind.
Any ideas, projects, conversations, or experiments already in motion — even loose ones.
Name the outcome, not the activity. Not "I want to feel better" — what would actually need to be true?
05
The Real Obstacles
Most resistance is internal. Let's name it now so it doesn't ambush us later.
Habits, situations, relationships, stories you keep telling yourself. Anything you've been putting up with longer than you should.
The voice that says you're too old, too late, too set in your ways, or "not the type." Name it directly.
Doing the work and nothing changing? Discovering something uncomfortable? Starting and not finishing? Say it plainly.
Time, financial, health, family obligations — anything that must be factored into what we build together.
06
How You're Wired
Helps me coach you the right way, not just the standard way.
Certain approaches, tones, or dynamics that just don't work for you.
1 = curious but not sure; 10 = completely bought in and ready to do the work.
Not sure yet
All in
Do you thrive with regular check-ins and clear deadlines? Or do you do better with more autonomy and reporting back on your own terms?
07
Anything Else
What I should know that I didn't think to ask.
Health, family, finances, a major transition — anything that might affect how we work together or what pace makes sense.

Your answers are private and used only to prepare for our coaching sessions. Thank you for taking this seriously. The quality of what you write here sets the tone for everything that follows.