New Client Intake Questionnaire

To prepare for our coaching relationship and first session, please answer the following questions. All information will remain confidential.

Name: *

First

Last

Today's date: *

Where do you live? (city, state, country): *

Telephone number: *

Email: *

Date of birth: *

Marital status: *

Children & ages (if applicable):

Occupation: *

I am optimistic *

On a scale of 1 to 10, with ten being the highest, pick the number that represents how you would describe yourself. Do this for the next five areas.

I am satisfied with my life *

I am satisfied with my health *

I am satisfied with my financial situation *

I am satisfied with my social life *

I feel good about my personal relationships *

1. What are your most significant accomplishments? *

2. What are some disappointments you have experienced in life? *

3. Describe your top three strengths: *

4. Describe any weaknesses you may feel you have: *

5. I am happiest when I *

6. I feel lowest when I *

7. If I could do anything, I would *

8. What are the top 1–2 goals you want to focus on during our time working together? *

9. What makes these goals important to you right now? *

10. What would meaningful progress look like by the end of our time working together? *

11. What has held you back from making progress until now? *

12. What strengths, skills, or resources do you already have that can help you succeed? *

13. Have you worked with a coach before? *

14. If yes, how was your experience?

15. How do you prefer to be coached? *

(e.g., direct, gentle, accountability-focused, reflective)

16. What kind of support keeps you consistent and motivated? *

17. Is there anything else that would help me understand how to support you best? *

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