• Client Intake Form

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  • Take some quality time to complete this information form.  Some questions you’ll find easy to answer and others will cause you to stop and think.  This information will be equally valuable for both of us in creating your coaching plan.

    What are your current top three goals?

  • Have you worked with a coach before or a similar one-on-one adult relationship (e.g. tennis coach, piano teacher, therapist)? If yes, what worked well for you and what did not work in the relationship(s)?

  • What are the three biggest changes you want to make in your life over the next 3 years?

  • What would you say have been your 3 greatest accomplishments to date?

  • What major transitions have you had in the past two years? Entering or approaching a new decade, a new relationship, a new job, a new role, a new residence, change in children’s ages/stages, etc.?

  • Improvements

    List improvements you would like to make in the following areas of your life.

  • Is your life one of your choosing? If not, which parts are being chosen for you?

  • What are your primary stressors?

    List five things that you are tolerating or putting up with in your life at present. (examples: info. you can’t find, clutter, rude friends, poor lighting, tight shoes, dented car, job dissatisfaction, dead plants, broken equipments, old appliances, etc.)

  • Your Life

  • Here are ways coaching clients work with me.  Which appeal to you?

  • If you reach the age of 95 and continue to live your life the way you are right now, what regrets do you think you will have? (tip: complete the statement "I wish I had…") Do not include things from the past–only things you will regret if you continue your exact present path.

  • Reload
  • Should be Empty: