Coachee Profile
Intake - Coachee Profile
Email address *
Today's Date: *
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Name: First, Last *
Your answer
Place of Employment *
Health Center (Location) or School Name *
Your answer
Cell Phone *
Your answer
Skype Name and Number only if Preferring Skype
Your answer
In case of a coaching appointment change, how should I contact you? *
Which communication would you like to use for coaching? *
Birthday Month/Day(Year optional) *
Your answer
Briefly describe your daily work, who you work for/with and where you do it? *
Your answer
Describe what brings you joy and how often you choose to be joyful? *
Your answer
What brings you to coaching at this point in your life? *
Your answer
List 3 strengths you believe you have and how you use them in your life? *
Your answer
If you are a parent please list your child's names and ages. *
Your answer
Anything else you would want me to know about you? (Please disclose any current medical/counseling issues if appropriate - all comments are confidential)
Your answer
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