Peer Coaching Intake Questionnaire

To help us make the most of our coaching relationship and first session, please complete this questionnaire based on where you are today. There are no right or wrong answers. Share only what you are comfortable sharing. Your responses will remain confidential.

Name: *

First

Last

Today's date: *

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

Telephone number:

Email: *

Occupation / Role: *

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. Are there any areas you want to strengthen or improve? *

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? *

Phone