New Client Intake Assessment

Today’s Date:

Your/Organization Name:

Your/Organization Phone Number:

(Organizations Only) – Approximate Number in Group:

(Organizations Only) – Best Contact Name & Number:

Type of Agency (if applicable):

Address:

Secondary Contact Info (if applicable)

Additional Information:

What are your current needs, or needs of your organization? What specific resources are you seeking?

After reviewing who we are, how can HDC benefit your or your organization’s mission, values, and belief systems?

What are your or your organizations short and long-term goals, regardless if you choose HDC to support you (i.e., academic calendar goals)?

Are there any other needs or thoughts regarding potential collaboration for the future?

Describe the types of trainings that you or your organization have participated in before? What has been the feedback from these trainings?

Please describe the backgrounds and any intersectionality of the staff/team (LGBTQI, Black/African American, Caucasian American, LatinX, Socioeconomic Status, Bay Area native/not, etc.)?

Would you be interested in scheduling any of the following HDC Services? If yes, an HDC Coach will be in touch to discuss more!

Yes, and I will select my desired services below.

Yes, but I will select my desired services later.

No, I’m not interested at this time.

Intake

An HDC Coach will discuss the history of the company, describe their coaching style, and assess the needs of the client, actively listening to the desired goals as described by the client. – Price Determined Upon Consultation

Life Skills Development

An HDC Coach will support client(s) through a mindfulness practice of R.A.M. (Relationship-Accountability- Mentoring), improving various life skills development challenges, including supporting with individual and group engagement, time management, and project completion. – $500/Hourly Session

Professional Development

An HDC Coach will support clients through a mindfulness practice of R.A.M. (Relationship-Accountability- Mentoring), improving various professional development challenges, including supporting with job coaching, employment readiness, and employment transitions. – $500/Hourly Session

Wellness Development

An HDC Coach will support clients through a mindfulness practice of R.A.M. (Relationship-Accountability-Mentoring), improving various wellness development challenges, including supporting with mindfulness improvement, self-reflection activities, and relaxation techniques. – $500/Hourly Session

Specialized Training

HDC will provide your staff with tailor made trainings that can empower staff to become more knowledgeable about trauma, crisis and various types of client engagement. – $500/Hourly Session

Specialized Consulting

HDC will provide a uniquely developed onetime consultation or weekly consultation that includes observation, assessment and written analysis. – $500/Hourly Session

Specialized Coaching

Professional development and vision planning, including weekly and monthly 1-1 phone and face-to-face coaching sessions. – $500/Hourly Session

One-Day Power Session

A specially crafted one-day power session for busy individuals and corporate executives. In these power sessions, you will have the luxury to work with Dr. Horn or Colette Reid-Horn as they support you with building your personal and professional goals. Aaron and Colette will provide you with all of the tailor made HDC tools along with their intellectual property and business management skills. – $1,500/Hourly Session

One-Day DYNAMIC Power Session

A specially crafted one-day power session for busy individuals and corporate executives. In these power sessions, you will have the luxury to work with Dr. Horn and Colette Reid-Horn as they support you with building your personal and professional goals. Aaron and Colette will provide you with all of the tailor made HDC tools along with their intellectual property and business management skills. – $3,000/Hourly Session

Customized Combination Package

HDC will customize packages tailored to your exact individual or group needs. Utilizing an array of HDC services, HDC will take a collaborative approach to find the combination of services that best suits your individual or group’s needs. – Price Determined Upon Consultation

If you cancel or reschedule your appointment, please call 48 hours in advance. If you fail to notify your HDC coach within 24 hours prior to your scheduled time of a cancellation, you will be charged the full rate.

I agree

N/A

Clients are expected to pay the agreed fee per 60-minute session at the time of each appointment. Payment must be made prior to your session. HDC currently accepts cash, check, and Venmo only.

I agree

N/A

Please select your preferred method of payment (you are not being charged at this time).

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New Client Intake Form

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