Client Information Form
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Name *
Cell phone number *
Describe your greatest accomplishments to date. *
What made these stand out for you? *
How can you use what you've learned to assist you in making future changes? *
What major transitions have you had in the past two year, if any? (i.e, new residence, job etc.) *
If you've worked with a coach or one-on-one adult relationship before (i.e. sports coach, therapist etc.), what worked well for you? *
Who are or have been your major role models? *
What attributes do you admire of these role models and want to emulate? *
What are the five most positive things in your life right now? *
What are the five things you would like to change in your life that would make it even more satisfying? *
Who are the key supportive people in your life, and what do they provide for you? *
On a scale of 1 to 10 (1 being least effective and 10 being most effective), rate your quality of life. *
Least Effective
Most Effective
What criteria did you rate yourself by? *
What percentage of the life you are leading is YOUR life? *
List 5 adjectives that describe you at your best. *
What enables you to be at your best? *
What prevents you from being at your best? *
What energizes you? *
What depletes your energy? *
What are you learning and accepting about yourself at the present? *
Tell me about your best experience with a healthy lifestyle. *
What do you value most about good health? *
What is your personal vision? *
What do you want to achieve personally in the next six months? How about year? *
How ready are you to go for it? *
What excites you about working with me? *
What are three immediate changes you can make to get you off to a good start in our coaching? *
How can I help you to be more effective in working toward your goals? *
Here are some ways coaching clients work with me. Which of these appeal to you? (Select as many as apply.) *
Required
What approaches to change how you found less effective for you? *
What responsibility do you have for ensuring that our relationship works well? *
How will you know that your coaching experience has been effective? *
What do you hope your situation looks like at the end of our coaching relationship? *
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