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First and Last Name
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Date of Birth
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Street Address
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City, State and Zip Code
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Home Phone/Work Phone
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Cell Phone
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Email Address
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What issues or concerns would you like to address or change or improve at this time?
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What led you to seek change now?
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What is the outcome you desire, and how will you know you have achieved it?
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In your current situation, what issues do you struggle with most? How do you know when you are upset about it?
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What or who is most important to you in your life, and how do you know?
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What are your major concerns and why?
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List your top 5 values
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What is your purpose, vision and mission for your life?
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What are your greatest business or professional goals?
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What are your professional strengths?
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Name at least 3 accomplishments in your life that you are most proud of. Why?
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List 5 to 10 goals you have currently, but have not yet achieved.
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List the top 5 goals you want to accomplish within the next 12 months.
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List the top 5 goals you want to accomplish in your lifetime.
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What are you willing to do to achieve your goals?
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What or who is holding you back keeping you from achieving your goals?
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What do you most want to get out of a coaching relationship?
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How would you know if the coaching relationship is successful, and that you are getting what you need from it?
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