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Coaching Intake Questionnaire

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Coaching Intake Questionnaire

To be completed in advance of your Coaching Intake Session with your coach.

(Note: The Coaching Intake Questionnaire will take approximately 30 minutes to complete. If you're unable to complete the full questionnaire in one sitting, the form will reset if you close your browser.)

First Name *

Last Name *

Phone number *

Email *

Have you ever been coached? *

If you have been coached, what type of coaching did you receive? Was it a positive experience? Otherwise enter "N/A". *

What is the quality of your key relationships at work and at home? *

Extremely Positive & Fulfilling Positive & Fulfilling Moderately Positive & Fulfilling A Mix of Positive & Negative Elements Moderately Negative & Draining No Relationship N/A

Manager

Collegues

Spouse / Partner

Children

Parents

Siblings

Other

Please specify relationships listed as "Other". Please list who this person is and their relationship with you. Otherwise enter "N/A". *

Do you have close friends and/or a best friend with whom you regularly interact and spend time? Please describe the quality of your friendship(s) and the role they play in your life presently. *

Does spirituality and/or religion play a role in your life? If so, please explain its importance. *

What kind of work do you do? Do you find it fulfilling? Briefly describe what you do and the degree to which it is fulfilling for you. *

Can you answer the question, "What is it that I really want from my life?" If so, what is it that you really want? If you can't answer this question, why do you suppose that is the case? *

To what degree do your outcomes (at work, home, and in your relationships) reflect the results you'd ideally like to have? *

To a high degree

To a moderate degree

To a low degree

Not at all

What is it that you are hoping to get out of being coached? List at least three expectations you have identified that you'd like to get out of the experience of being coached. *

Where are you located, or what time zone are you in? What restrictions or requests do you have for scheduling of one-on-one coaching time? *

Is there anything else you feel is important for your coach to know? If so, what is it? If not, simply write a fun or obscure fact about yourself.

Coaching Intake Questionnaire

Click Submit to finish.