New Client Intake Form

Personal Information

First name

Last name

Phone

Address

Birthday

Month

Day

Year

Occupation

What mindset, career, life, and/or personal goals are you interested in exploring?

What are the top 3 goals or changes you want to achieve within the next year?

What makes attaining those goals complex or challenging?

What systems do you currently have in place to help you reach your goals? Are they working for you?

Where do you see yourself 6 months from now, when this program is over? What will it take to get there?

What would you consider as 3 signs of progress that you are moving in the right direction?

What insights do you have about what is holding you back? (time, money, people, habits, lack of confidence, fears, assumptions, etc.)?

Please list the names and relationship with the 5 most important people in your life

What do you value most in your life right now?

What core values guide your decision making?

Where do you get your support and encouragement from?

Tell me how you see the world?

How do you define being the best version of yourself?

What does success mean to you?

How do you tend to sabotage yourself?

How do you release stress?

How do you best learn? What is your learning style?

Have you worked with a coach previously? If yes, what was your experience like?

What would you LOVE to see happen as a result of your coaching experience—and why?

On a scale from 1-10 how committed are you about making the changes necessary to succeed?

How rigorous do you want me to be as a coach?

Please list any available assessments that you have taken within the last 18 months

What else might be important to share as we work together?