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Call: (+234) 809 999 7025
Call: (+234) 809 999 7025
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ASSESMENT FORM
At Lruc, we belive that true transformation Begins within and from there, flows into relationships, families, communities and organisation
LRUC Client Intake Form- Life and Relationship University & Clinic
Thank you for taking the first step toward healing, growth, and transformation. This form is designed to help us understand your needs and goals so we can connect you with the most suitable coach, therapist, or support program tailored just for you. Whether you’re here for personal healing, relationship support, premarital counseling, emotional wellness, or life coaching, your journey matters and we’re honored to walk alongside you. Please answer the questions as honestly and clearly as possible. All information shared here will be kept strictly confidential and used only for the purpose of recommending the best care and support. Let’s begin the journey to wholeness together
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Name
*
First
Last
Gender
*
--- Select Choice ---
Male
Female
Age
Occupation
What area do you need support with? (Check all that apply)
*
Individual counseling or therapy
Relationship/marriage coaching
Pre-marital counseling
Parenting support
Trauma healing
Mindset and emotional mastery
Spiritual or life direction
Personal development/life coaching
Corporate/emotional intelligence training
Please describe briefly what you're currently going through or what you'd like help with.
*
What outcome are you hoping for from this experience?
Preferred session type
Online (Zoom/Google Meet)
In-person
No preference
What are you looking for?
One-time session
Short-term package (2–4 sessions)
Longer journey (6+ sessions)
Preferred coach/therapist gender
Male
Female
No preference
How ready are you to begin this journey?
I’m just exploring options
I’m ready to begin now
I’d like to talk it through first
Would you prefer a self-paced program, a one-on-one or group coaching
self-paced
One-on-one
Group Coaching
for are call?
Would you like us to recommend a coach, therapist, or program based on your answers?
Yes
No
Maybe (please contact me with options)
Would you like us to contact you to schedule a free clarity call?
Yes
No
Additional comments or message:
Consent:
I consent to have my responses reviewed to match me with the appropriate coach or program.
Thank you for trusting LRUC with your journey! We’ll review your responses and connect you with a suitable coach, therapist, or program within 24 hours. We look forward to supporting your healing, growth, and transformation.
Submit
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