Coaching Intake Form
Thank you for coaching with me!  

Muhammad W. Hijazi
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Phone Number
رقم التليفون
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Full Name
الإسم
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Dat of Birth
تاريخ الميلاد
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Address
العنوان
Q0. Which Coaching Service(s) You're Interested in?
أي خدمة كوتشنج تناسبك؟
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 Q1. What would you love to see after our Coaching sessions?
مالذي تحب ان نصل اليه بعد جلسات الكوتشنج؟
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 Q2. Tell me more about your story and the significant events that have shaped who you are today.
أخبرني اكثر عن حياتك وماهي الأحداث المهمة التي صنعت منك شخصيتك الحاليه
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Q3. What is working well now in your life?
مالذي يسير على مايرام في حياتك الآن؟
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Q4. What is not working so great? What would you like to change?
مالذي لا يسير  على مايرام الآن في حياتك؟
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Q5. What has been your personal development until this point?
ما الإنجازات التي حققتها لنموك  الشخصي؟
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Q6. What has been your biggest obstacle?
ماهي العوائق الكبيره امامك الآن؟
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Q7. Have you been to a therapist or coach before?
هل ذهبت لطليب نفسي او كوتش  من قبل؟
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Q8. What are your current top 3 biggest life challenges and why?
اكبر ٣ تحديات ولماذا
Q9. List 3 short-term goals you would like to work on with measurable results for each over the next 30 days (Hint: keep these simple)
اكتب ٣ اهداف تريد الوصول لهم خلال ال ٣٠ يوم  القادمه
Q10.  List 3-6 more goals you would like to work on over the next 6 months with measurable results for each. (Hint: this is the time to stretch yourself!)
٣ اهداف  بعد ٦ شهور
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Q11. What would you like your life to be like 12 months from now? DREAMING BIG FOR SURE ON THIS ONE ;-)
كيف تحب أن ترى حياتك بعد 12 شهر من الآن؟
Q12. What do you think is holding you back or has slowed your progress up to now (resources, understanding/knowledge of new tools, friends, family, mentors, inner mindset)?
ما الذي يمنعك او يقلل من تقدمك في الحياه؟
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Q13. If you could change ONE thing in your life right now- what would it be ?*(Hint – don’t overthink on this one – go with the first thing that pops into your mind.)
ان كنت تستطيع نغيير شئ واحد .. فما هو؟
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Q14. What is the biggest opportunity/resource that you’re not taking advantage of?
ما هي اكتر مزايا وامكانيات لديك ولا تستخدمها؟
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Q15. What are the negative things you typically tell yourself? (Make a list, please.)
ما هو الحديث السلبي الذي غالبا ما تحدث به نفسك؟
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Q16. What do you desire as your MAGICAL Leap in life for the next 4 months?
لو معاك مصباح علاء الدين السخري  .   تحب تطلب ايه؟
Q17. Results are an issue of personal responsibility simply signing up to work together is no guarantee that you will achieve results. BUT please know I am committed to your progress, and need you to do the same for yourself. Are you ready and willing to make the changes necessary to achieve your goals?
سابذل كل جهدي في رحلة الكوتشنح ولكن تحقيق النتائج يعتمد على التزامك بما نتفق عليه من تدريبات  وواحبات حتي حتى بحدث التغيير ..  فهل انت مستعد لذلك؟
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Q18. How do you want me to support you, if I notice that you are falling off track? (I’m always loving... no worries!)

كيف تريدني ان أدعمك وأساعدك إذا مالاحظت تكاسلت او لم تفعل ما أتفقنا عليه؟
Q19. What is the most empowering and helpful thing I can do for you during our time together?
؟ما هو اكتر شئ يعطيك الحماس والطاقة  تتوقعه منى كمدرب ومستشارك
Q20. Hooray! You have already completed one of the most important steps to reaching the next level in your life! Give yourself a pat on the back and go celebrate. A note about me : I work best with those who are willing, rather than those who doubt or resist everything. What it comes down to is: I truly want the best results for you out of our work. Do I have permission to gently call you on using excuses, avoiding, resisting recommendations if I see it happening?
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