Client Intake — Scale With Michelle

About you

Email

Full Name

Date of birth?

What is your shipping address?

Access & contact

Do you have a LastPass account? If so, STOP here and please share the requested vendor, accounts and login details outlined in this form via LastPass.

Yes No

What is the best way to reach you?

SMS Email Phone Call

Please provide your best contact information below.

Please provide the login and password of the email inbox we will be managing.

Do you have a scheduling link for 1:1 calls? If so, please provide the link below and admin login details

Do you use a video calling platform for virtual trainings or calls? If so, please provide the link below

Travel

Are you under a hotel rewards/loyalty program? If so, please select all that apply and complete the next section.

Please provide your rewards/loyalty program login details below.

Do you prefer a high floor when booking hotel stay?

Yes No

Are you a part of a frequent flyer rewards program? Please select all that apply. If so, please complete the next section.

Please provide your SkyMiles /Frequent Flyer /Rapid Rewards program login details.

Please provide your SkyMiles / Frequent Flyer / Rapid Rewards and or KTN numbers

Your team

Name and contact number/email for each preferred vendor.

Please provide the name and contact number/email of your preferred wardrobe stylist.

Please provide the name and contact number/email of your preferred hair stylist/barber.

Please provide the name and contact number/email of your preferred MUA.

Please provide the name and contact number/email of your preferred esthetician.

Please provide the name and contact number/email of your preferred lash tech.

Please provide the name and contact number/email of your preferred waxing tech.

Service Providers

Name and contact number/email for each preferred provider.

Please provide the name and contact number/email of your preferred masseuse.

Please provide the name and contact number/email of your preferred lawn care provider.

Please provide the name and contact number/email of your preferred handyman.

Please provide the name and contact number/email of your preferred dentist.

Please provide the name and contact number/email of your preferred gynecologist.

Please provide the name and contact number/email of your preferred primary care physician.

Please provide the name and contact number/email of your preferred eye doctor.

Please provide the name and contact number/email of your preferred fitness trainer.

Please provide the name and contact number/email of your preferred chef.

Please provide the name and contact number/email of your preferred event coordinator.

Please provide the name and contact number/email of your preferred childcare provider.

Please provide the name and contact number/email of your preferred graphic designer.

Please provide the name and contact number/email of your preferred photographer/videographer.

Please provide the name and contact number/email of your preferred A/V engineer.

Please provide the name and contact number/email of your preferred PR contact.

Insurance

Name and contact number/email for each preferred provider.

Please provide the name and contact number/email of your preferred homeowners insurance provider.

Please provide the name and contact number/email of your preferred car insurance provider.

Please provide the name and contact number/email of your preferred life insurance provider.

Emergency Contacts

Name and contact number/email for each emergency contact.

Emergency contact (parent) — please select all that apply.

Mother Father

Emergency contact (sibling) — please select all that apply.

Brother Sister

Please provide the name and contact number/email of your emergency contact (other family/friend).

Preferences

Do you have any food allergies? If so, please list them all below.

Please provide your food and beverage preferences (i.e. Smart Water, blueberries, m&m's, etc.)

Please provide other information that you may feel is necessary for us to know below.

Client Intake Form