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HOME
BENEFITS
SERVICES
ABOUT US
BLOG
Events
GET STARTED
CONTACT US
Privacy Policy
Client Information
Client Information
Name
*
First
Email
*
Date
*
Date Format: MM slash DD slash YYYY
Please rate your satisfaction with your life in the following areas:
(1 – worst, 5 – best)
Family/home
*
Please enter a number from
1
to
5
.
Financial
*
Please enter a number from
1
to
5
.
Career or business
*
Please enter a number from
1
to
5
.
Personal character
*
Please enter a number from
1
to
5
.
Relationships
*
Please enter a number from
1
to
5
.
Leisure time
*
Please enter a number from
1
to
5
.
Self-care
*
Please enter a number from
1
to
5
.
Learning
*
Please enter a number from
1
to
5
.
Spirituality
*
Please enter a number from
1
to
5
.
What changes would you like to make in the following areas of your life:
Family/home
*
Financial
*
Career or business
*
Personal character
*
Relationships
*
Leisure time
*
Self-care
*
Learning
*
Spirituality
*
What one thing do you want more of in your life right now?
*
What one thing do you want less of in your life right now?
*
List three things you are tolerating right now in your personal life.
*
List three things you are tolerating right now in your work life.
*
On a scale of 1 to 10 (10 being highest), rate the amount of stress in your life right now.
*
Please enter a number from
1
to
10
.
What are your primary stressors?
*
What are you addicted to? (alcohol, sugar, adrenaline, etc.)
*
List 5 adjectives that describe you at your best:
1.
*
2.
*
3.
*
4.
*
5.
*
List 5 adjectives that describe you at your worst:
1.
*
2.
*
3.
*
4.
*
5.
*
What’s one thing you would like to achieve but aren’t sure how to do it?
*
Listed below are some typical results experienced by coaching clients. Which 3 are most important to you?
*
direction
focus
accountability
a new perspective
relationship success
strategies
better finances
motivation
new challenges
other-please list
*
How well do you keep your commitments when taking advice or working with someone towards your goals? (very, moderately, not too much)
*
How do you like to be supported when hitting challenges in your personal growth or thought process (have a good listener; strategize with someone; work with a devil’s advocate, work with guided visualization, journal, etc. If you’re not sure, you can write that too.)?
*
Do you have any specific goals and/or intentions for coaching?
*
How committed are you to making this coaching relationship work for you?
*
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