Client Portal - Cognition Ignition, LLC

Welcome to Your Client Portal

Complete your intake forms and access resources to begin your transformation

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Client Intake Form

Complete your initial assessment and background information

Start Form

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Performance Assessment

Evaluate your current performance levels and goals

Begin Assessment

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Consultation Request

Schedule your initial consultation session

Schedule Now

Client Intake Form

Please provide detailed information to help me understand your background and goals

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Preferred Contact Method

Professional Background

Company/Organization *

Current Position/Title *

Industry *

Years of Experience in Current Role

Team Size (if applicable)

Goals & Objectives

Primary Goals for Coaching *

Current Challenges *

How do you measure success?

Background & Experience

Previous Coaching Experience

NLP/Hypnotherapy Experience

Availability for Sessions

Confidentiality & Consent

I understand and agree that all information shared will be kept strictly confidential. I consent to participating in NLP and hypnotherapy techniques as part of my coaching program.

I would like to use encrypted communication channels for sensitive discussions.

Performance Assessment

Evaluate your current performance levels across key executive competencies

Rate yourself on a scale of 1-10 (1 = Needs Significant Improvement, 10 = Exceptional Performance)

Leadership & Communication

Communication Effectiveness

1 10 5

Team Leadership

1 10 5

Negotiation Skills

1 10 5

Decision Making & Strategy

Strategic Thinking

1 10 5

Decision Making Under Pressure

1 10 5

Problem Solving

1 10 5

Personal Performance

Stress Management

1 10 5

Confidence & Executive Presence

1 10 5

Work-Life Balance

1 10 5

Additional Information

What is your biggest professional strength?

What area needs the most improvement?

Consultation Request

Schedule your initial consultation to discuss your goals and program options

Full Name *

Email Address *

Phone Number *

Program of Interest

Preferred Consultation Time

Consultation Format

Timeline

Topics to Discuss

This consultation will involve confidential or sensitive business matters

Client Resources

Getting Started

New to NLP and executive coaching? Here are some resources to help you prepare for our work together:

Understanding NLP basics
Preparing for your first session
Setting realistic expectations
Maximizing your coaching investment

Privacy & Security

Your confidentiality is paramount. Learn about our security measures:

Encrypted communication options
Data protection policies
Confidentiality agreements
Secure session protocols