Coaching Intake Form
You've chosen coaching. Congratulations! To get the most out of our time together, a few quick questions to begin.
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Name - First, Last + Preferred Nickname (if applicable)
What brings you to coaching? Why now? *
What in the world makes you feel joy?
Do you have any specific goals you would like to focus on during coaching? (*Or anything in particular non goal related:)
Do you have any current stressors or obstacles to moving forward? If yes, please describe.
Knowing that these numbers fluctuate throughout our lives and that how we rank them will shift throughout our lives... For where you are right now in your life (not where you intend to be one day) Please rank each of the following on a scale of 1-10. (1=miserable, 10=excellent)
10
9
8
7
6
5
4
3
2
1
Career
Camaraderie | Family & Friends
Finances
Fun / Recreation
Health | Mental & Physical
Environment
Companionship / Romance
Spiritual / Personal Growth
Clear selection
Are you currently under the care of a mental health professional, psychologist, or psychiatrist? If yes, what are they treating you for? Are you on any antidepressant or other psychological medications? Please include anything else about your mental or physical health that you feel may be relevant to your coaching experience and success.
What else would you like me to know about you?
By choosing to move forward, you agree to show up, participate fully, and commit to growth during our coaching sessions and in your life! Are you willing and able to make your well being a priority in your schedule and in your life? *
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