New Client Intake

Welcome to Coaching!

I’m so glad that you decided to invest in yourself! I look forward to working with you as you look at where you are now and where you want to be. Let’s get ready to begin a journey of exploration, to be open, and to create a life that is in alignment with who you are and who you want to be.

First name

Last name

Cell Phone

Billing Address, City, State Zip

Home Address, City, State, Zip (If Different)

Occupation / Job Title

Birthday

Month

Day

Year

Names of Important People in Your Life

Intake Questions

Please answer the following questions and return them to me prior to our first session. All of the questions are optional. Please be as brief or as detailed as you choose.

What do you want to get out of coaching?  

What do you want to happen in your lifetime so that you consider your life satisfying and well lived?

If there were a secret ambition in your life, what would it be?

Describe your “dream career” (what, when, where, with whom?)

Describe your support system. Do you have people in your life who believe in you, encourage you, challenge you and see you through the hard times?

What are five of your “gifts” or talents?

What do you have to contribute that is unique?

How are you your own worst enemy?

What has been your most thrilling success or proudest achievement?

What activities have meaning and heart for you?

Who inspires you?

What are three things you have been procrastinating on?

What is the greatest personal change you’d like to see in the coming year?

What is most important to you?

Who do you want to be?

Who are you?