Pre- Coaching Discovery Form
If you are completing this form on a smart phone, please turn your orientation to horizontal.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthdate
-
Month
-
Day
Year
Date
Occupation/What do you do to earn a living?
Back
Next
Please complete this sentence in the space below: It's really important for me not to be perceived as
If you had a PAID year off, how would you spend your days?
1. Look forward 20 years… you are attending a function where someone is giving a speech about YOU! What would you want them to say?
2. What movie, song, book, poem moves you to tears, if any?
3. Think about one or two people you know who really inspire you. What about them is inspiring?
4. What's missing in your life, the presence of which would have your life be more fulfilling?
5. What would you do if you knew you could not fail?
6. What are your spiritual beliefs? Do you believe in the concept of a higher power?Describe the most useful, empowering aspects of your spiritual beliefs.
7. What activities have heart and meaning for you?
8. What needs in the world are you moved to meet, if any?
9. What two steps could you immediately take that would make the biggest difference in your current situation?
10. When are you UNABLE to laugh at yourself?
11. When do you give your power away? To whom?
12. What drives you crazy?
13. What do you contribute that is unique?
14. What special knowledge do you have?
15. What can I say to you when you are “stuck” that will return you to action?
16. What else would you like for me to know?
Back
Next
17. What longing do you have that you are hoping Life Coaching will help you fulfill?
Back
Next
Skip this section if you do not have ADHD. The is the KORS ADHD rating scale. When it comes to the "lived" experience of ADHD, how is your life negatively impacted? If there are other areas of concern, please bring them up in your appointment.
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
Back
Next
Date
-
Month
-
Day
Year
Date
Coach Signature
Client Signature
Submit
Should be Empty: