Art of Life Coaching and Consulting Pre-Coaching Consultation Form
If you are completing this form on a smart phone, please turn your orientation to horizontal. Thank you for taking the time to share more information with me. There are no right or wrong answers. Sometimes, the answer may occur in specific settings or circumstances. That is okay. We will talk about it in our consultation.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthdate
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Occupation/What do you do to earn a living?
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Do you have a signficant other?
Do you have children? If so, what are their ages?
Look forward 10 years… you are attending a function where someone is giving a speech about YOU! What would you want them to say?
What would you do if you knew you could not fail?
What do you contribute that is unique?
What special knowledge do you have?
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The is the KORS rating scale for the most reported challenges that respond to coaching. When it comes to the "lived" experience with YOUR attention challenges how is your life negatively impacted? If there are other areas of concern, please bring them up in our meeting. Thank you!
Rows
Not at all
Annoys others
Slightly annoying to me
Pretty troublesome
Crippling
Meeting Deadlines
Task Completion
Remembering Commitments
Distractibility
Impulsivity
Overwhelm
Trouble Transitioning
Scheduling
Chronic Lateness
Procrastination
Hyperfocus
Rejection Sensitivity
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Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Coach Signature
Client Signature
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