Amanda Bailey | Flux & Flow | Client Intake Form
Getting to Know You
Name:
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Address:
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Phone Number(s):
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Email:
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Occupation and Company:
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Date of birth:
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Significant Other:
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Names and Ages of Children:
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Why do you want coaching? Be as specific as possible.
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Have you ever been in counseling or therapy? Please explain.
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Describe your spirituality.
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What are the most important things, good and bad, happening in your life right now?
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How would you like your life to be different one year from now?
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What is getting in the way of these goals?
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How could you sabotage yourself or me as your coach?
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List at least three things you procrastinate.
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What are your concerns about coaching?
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Rate the level of stress in your life (1-10) and what are your primary stressors?
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What would you like me to do if you behind in progress toward your goals?
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How do you like to be supported or held accountable?
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Why did you select me as your coach?
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What else would you like me to know about you?
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Adapted from Gary R. Collins. Used by permission of NavPress (www.navpress.com).
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