New Client Questionnaire

Please answer the following questions. There are no right or wrong answers. Some of the questions capture information about where you are today. (Mark N/A if a question is not applicable.) Other questions will make you curious about what you want from sessions, from your career, relationships, and from your life in general. Your answers will help us set a strong foundation for our sessions. If you feel some of the general coaching questions do not apply to you, just mark N/A.

First name*

Last name*

Address*

Email*

Phone*

Occupation*

Who referred you?

Can I send them a thank you card? (none of your personal information will be shared – just your name and a thank you for the referral).

YesNo

What is his/her address?

Goals for Our Work

1. What do you want to be certain to obtain from the sessions?*

2. What two steps could you take immediately that would help you move forward?*

3. What can I say to you when you are stuck that will help you move forward?*

4. What changes need to be made within yourself, or your life, to help your sessions to be successful?*

Career and Life Purpose

1. What do you want from your career? *

2. What projects are you involved with? *

3. What are your key career goals? *

4. What skills or knowledge are you developing? *

5. How do your career goals support your personal goals? *

6. What do you want to do to support your career goals? *

7. What do you need to change to help your career more forward? *

8. What do you feel is your life purpose?*

9. Do you feel your career is part of your life purpose at present? Why or why not?*

Personal

1. What special interests do you have? *

2. What special knowledge do you have? *

3. What do you believe in strongly? *

4. What do you do when things get stressful? *

5. What activities have special meaning for you? *

6. What vision do you have for your life? *

7. Tell me about your family and personal life: *

8. Do you have a specific spiritual path or belief system? If so, please describe in what ways this helps you in your daily life, career and personal growth:*

9. Tell me about significant events in your life: *

10. Tell me about any relationship or communication issues that you want to improve?*

11. What would look different in your daily life if you learned tools to improve this relationship or communication issue? (How would you know it had improved?)*

12. If you had three wishes to change/improve something in your life now, what would you ask for?*

Any other pertinent info you think I should know:*

I understand that my appointment slot is held especially for me and will be sure to give at least 25 hours/1 business day advance notice if I need to reschedule, so that someone else can be given that slot. Otherwise, I understand I will forfeit a refund or chance to reschedule my missed appointment.*

Please put your initials in this box.

New Client Questionnaire

New Client Questionnaire

Goals for Our Work

Career and Life Purpose

Personal

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