Coaching Intake Form 

Please complete prior to our first meeting. 

Name *
Name
Tell me something about your personal background. Where you are from, where you grew up, something about your family, and any other details that you think will help me better understand and better support you.
Tell me something about your work background. Where are you now and how did you get there? What is the most important thing you do in your work? What do you love about your work? What don’t you love about your work?
Why has coaching become a consideration for you? What types of challenges are arising that aren't working in your favor and need to be addressed? How would others who interact with you describe your management and communication style?
What habits/activities/thought processes do you believe need to be dropped, simplified, or let go of to truly move forward?
Is there anything else I should know that will help me help you?
Confirm Commitment *
Please read the following and confirm your commitment to our partnership. + I can be relied upon to be on time, prepared, and focused on all calls. + This is the right time for me to accept coaching. + I understand that it is my role to do the work necessary to get what I want in life. My coach’s role is to guide and support me. + I will follow through on the commitments I make. + I will give my coach the benefit of the doubt and "try on" new concepts or different ways of doing things. + I will speak straight (tell the whole truth) to my coach. + I am willing to feel uncomfortable feelings so that they do not sabotage my forward movement. + If I am not getting what I expect from my coach, I will ask for what I need. + I am willing to stop or change the self‑defeating behaviors which limit my success. + I see coaching as a worthwhile investment of my time and focus.

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