Client Profile Form

Hello and welcome!

Please complete all fields below, unless not applicable, so that I may better understand your wants, needs, and goals. I will personally review your submission so that you get the most out of our time together.

All information you provide is confidential, and will not be shared with others without your consent.

Patty Buccellato, AICI, CI

Personal

Name (Required)

Last Name (Required)

Email (Required)

Country

City

Street Number

State / Province / Region

Zipcode

Mobile Phone

Alternative Phone

Birthdate

Height

Unit of measure

Weight

Unit of measure

Hair Color

Eye Color

Skintone

Gender Identity

Is there anything additional about your gender identity you’d like me to know?

Lifestyle

Employer

Profession

Current Title

Your Professional Goals

Do you supervise any staff?

Yes No

If "Yes" above, describe briefly:

Do you have direct client/customer contact?

Yes No

If "Yes", what level?

How do others in your workplace dress?

How your co-workers see you? (image)

Do you travel for work?

Yes No

Do you travel by car?

Yes No

Do you travel by air?

Yes No

What part of country / climate?

Average Duration of trips:

Do you travel for pleasure?

Yes No

What part of country/climate?

What types of activities?

Do you do any business/social entertaining?

Yes No

What types of activities?

How do you spend your non‐work time (interests, hobbies, sports & activities)?

Your wardrobe

Briefly describe your current wardrobe

Types of clothes you dislike?

Favorite items in current wardrobe

Dominant fabrics in current wardrobe

Dominant colors in current wardrobe

Clothing maintenance habits (diligent, haphazard, etc.)

Shopping

Shopping habits (frequency, urgent need vs. planned; sale vs. regular price)

Annual clothing budget (choose carefully; consider outerwear, footwear, under garments)

Preferred stores

Body shape/figure challenges

What bothers you most about shopping for clothes?

Your Goals

What main objective or outcome would you like to achieve in our time together?

Describe the image you would like to project

Challenges with clothes or personal presentation

Message you would like others to perceive about you (check all that apply):

Other (describe)

Miscellaneous

Main indications of need for image management/style services

Site any examples i.e.: recurring apparel concerns, feedback from .... employer, peers, or others...., occasions where you’ve not felt comfortable with your appearance, feedback from related consulting or coaching services, etc.

Success Indicators

Outcomes that serve as evidence to you that your objectives for image consulting have been met.

Consulting/Coaching History

Please list other coaches or consultants you've worked with.

If applicable: What were your results?

Refined Images and/or Reboot Your Style?

Additional comments/concerns

Please list any objectives not addressed elsewhere in profile (if applicable).

...and you're all done!

Please make sure you completed all fields (where applicable) and click “Submit Form” to submit your questionnaire.
“All information you provide is confidential, and will not be shared with others without your consent.”
Patty Buccellato

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Client Profile form

Hello and welcome!

...and you're all done!