COACHING INTAKE FORM

PERSONAL DETAILS

First Name

Last Name

Phone *

Email *

Date of birth

Street Address

City

State

Country

Postal code

UNDERSTANDING YOUR CURRENT SITUATION

How would you describe your current life situation in a few sentences?

What are the three most signiﬁcant aspects of your life right now?

What feelings or emotions do you most often experience daily?

What are your biggest challenges or struggles at the moment?

How do you spend a typical day, and how does this align with your values and interests?

What aspects of your life do you ﬁnd most fulﬁlling? Least fulﬁlling?

How do you react to unexpected challenges or stressors?

VISION FOR YOUR FUTURE

If you could envision the ideal version of your life in ﬁve years, what would it look like?

What goals or dreams have you put on hold, and why?

What does success mean to you, and how would you know you’ve achieved it?

Are there any roles or identities you aspire to adopt or expand upon in the future?

What are some things you’ve always wanted to do but haven’t yet started?

How does your future self differ from who you are today?

IDENTIFYING OBSTACLES

What do you feel is holding you back from achieving your dreams or goals?

Can you identify any fears or beliefs that might be limiting your potential?

How do you typically deal with failure or setbacks?

In what areas of your life do you feel the least conﬁdent or capable?

Are there any external circumstances or people you believe are inﬂuencing your current situation negatively?

How do you prioritise your time and energy, and do these priorities reﬂect your true objectives?

PATHWAYS TO CHANGE

What steps have you taken in the past to change your situation, and what were the outcomes?

What resources (time, money, support networks) do you currently have at your disposal that could aid in your transformation?

Who in your life supports your growth, and how do they do so?

What are you willing to sacriﬁce or change in your life to achieve your goals?

How do you learn best, and how can this style be applied to your transformation process?

Can you think of a time when you successfully overcame a challenge? What did you learn from that experience?

COMMITTMENT AND MOTIVATION

What motivates you to get out of bed every morning, and how can we harness this motivation towards your goals?

How do you deﬁne personal growth, and what areas of growth are most important to you?

What are you most passionate about, and how can we integrate this passion into your life goals?

How do you envision a coaching relationship helping you to overcome your current challenges?

What are the ﬁrst steps you feel ready to take towards transformation?

Sign Here to Agree That You Are Ready To Commit To Yourself and The Process.