Getting to Know You…

Contact Information

First Name*

Last Name*

Phone*

Email*

Street*

City*

State*

Zip Code*

Date of Birth*

In the unlikely event that an emergency arises during our conversation, please provide an emergency contact that I may call…

Emergency Contact*

Relationship*

Phone*

Coaching is more effective if you can give the coach some information about yourself at the beginning. This is confidential information and you are free to pass on answering any of these questions. The more you complete, however, the better your coach will know you and be able to provide the best possible coaching experience.

Why do you want coaching?

Have you taken any assessments or profiles that have helped you grow in self-awareness? Please list the names of the assessments and your results. examples: Strengths Finder, DiSC, Myers-Briggs Trait Indicator, Spiritual Gifts Assessment, etc.

Are you currently or have you ever been in counseling or therapy? If yes, please briefly explain.

What are your top 3 coaching goals?

In what ways do you sense God might be challenging you, nudging you in a different direction, or trying to get your attention?

What are the most important things (good and bad) happening in your life right now?

In what ways would you like your life to be different one year from now? Please be specific.

What is getting in the way of these goals?

List at least three things you procrastinate at—the things that you’ve been putting off.