Welcome Pack Questionnaire

Hello and congratulations on taking the first step to a healthier, happier and more fulfilling life!

This Welcome Pack will help you to start thinking about your life in a different way, become more aware of what you want to get out of this coaching process and identify what issues need to be addressed. It will also give me an insight into you and your unique situation and act as a starting point for the initial exploratory stage of the coaching process.

As your coach, it’s important for me to understand how you view the world, yourself, and your job or career. Each person is unique and understanding this will help me support and assist you.

Answering these questions clearly and thoughtfully, will serve both you and me. You may find that they help you clarify perceptions about yourself and the direction of your life. These are “pondering” type questions, designed to stimulate your thinking in a way that will make our work together more productive. Take your time answering them. If they are not complete by our first (foundation) session, just bring what you have completed and finish the rest later.

The information in this document and any further information relating to you that we discuss or document throughout our coaching partnership will be securely stored and treated with complete professional confidentiality. Your personal files will be securely stored for 12 months from the date of our last session unless otherwise agreed in writing between us. Should you wish to review any of your personal files at any stage, or change any personal details, this can be requested in writing and will be shared with you within 5 working days.

Please sign and date below to confirm you understand the reasons why the information in this form is required and that you agree to sharing it under the terms outlined above.

Signature

Date

Full Name

First NameLast Name

E-mail Address

example@example.com

Contact Number

Address

Street Address

Street Address Line 2

CityCounty

Post Code

Date of Birth

DayMonthYear

Marital status

MarriedCo-habitingSingle

Do you have any children?

YesNo

Please provide details - how many and their ages, and any information that may be relevant.

Are you pregnant, post-partum

What are you looking to achieve from our coaching relationship? What is your biggest goal you would like to achieve?

What’s the best way for me to work with you? What tips would you give me about what would work best? eg. Are you a person who likes to work from a list, do you like lots of small steps or do you sometimes need a gentle push to help you make a leap? Do you like to work alone or talk things through collaboratively?

Do you know much about the coaching process?

Do you have any apprehension or pre-conceived ideas about coaching?

What are the top 3 things about your life that you think it’s important for me to know right now?

What accomplishments or events must, in your opinion, occur during your lifetime to consider your life satisfying and well lived?

Is there a secret passion in your life? Something you may or may not have allowed yourself to do so far, but which you would really love to do? (Throw off the shackles here and go wild!)

What are your unique talents, gifts or skills? What would the people who know you best say you are good at and have to offer the world?

What gives you a sense of purpose and meaning in life? What drives you to get up in the morning?

Is there currently something missing in your life, the presence of which would make your life more fulfilling?

What do you do or how do you respond when you are really under pressure?

As your coach, my job is not to “treat” you, but to be your ally and your support. When it comes to health and wellness issues I will help you discover steps you may choose to take towards greater health and higher levels of wellness.

As your ally, I may refer you to medical, psychological and other health-related services for more information and to seek any treatment in these areas. I can be a source of support and accountability, helping you to follow through with any treatment plans that you devise with these other professionals.

By answering the questions below, I will more fully understand your health challenges and aspirations for higher levels of wellness.

Please rate your level of health and wellness on a scale of 1 to 10 with 1 being very unhealthy and unwell and 10 being the optimum level of health and wellness.

Describe what you do to be healthy and well.

Please describe any health challenges that you currently experience (include major concerns as well as little niggles like headaches, minor skin conditions, insomnia or tiredness)

Are you currently under the supervision/guidance of any other healthcare professional?

YesNo

Please provide any relevant information

Please list and medications or supplements you are taking and the reasons for taking these.

How stressed do you feel in your daily life? Again, please rate this on a scale of 1 to 10 with 1 meaning little or no stress and 10 being super-stressed and hard to function due to it.

Please outline the main causes of any stress in your life.

What do you currently do to reduce stress, or to counteract the effect of stress in your life?

Please describe a typical week in terms of diet and exercise/movement.

What do you do (or would you like to do) that brings you happiness and joy? How often do you do this?

What gets in the way of you doing what brings you joy and happiness in the world?

Can you think of 2 things you could change in your life or 2 small steps you could make right now that would have a positive impact on your current health and wellness?

Welcome Pack Questionnaire

The Coaching Relationship

Personal Information

Health & Wellness Information