The Path To Your Highest Potential
Noble One Coaching Discovery Form
"When you catch a glimpse of your potential, that's when passion is born." Zig Ziglar
The Basics
Date
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Month
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Day
Year
Date
Which coaching path are you interested in?
Teen Coaching
Adult Coaching
Virtual Group Coaching
Client Name
*
First Name
Last Name
Client Date of Birth
*
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Month
-
Day
Year
Date
Client Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Guardian's Name (If Client is Under 18)
*
First Name
Last Name
Legal Guardian's Phone Number
*
-
Area Code
Phone Number
Best Contact E-mail
*
example@example.com
Mental Health History
Is the client currently in counseling, therapy, or any other type of support?
*
Has the client been diagnosed by a licensed clinician? If yes, what is the condition and who is the clinical contact?
*
Has the client been prescribed any medications that we need to know about?
Discovering You
Noble One Coaches are excited to learn more about you! These questions will help us understand how we can best support you exactly where you are now and guide you to where you want to be. Noble One's intention is to help you identify any challenges and turn them into opportunities for personal growth so that you feel empowered with confidence, equipped with skills, and aligned with the highest version of yourself.
What areas would you like to work on with a coach? Check any that apply.
Managing Emotions and Coping Skills
Organization and Time Management
Feeling Stuck and Wanting to Move Forward
Managing Relationships With Friends & Family
Goal Setting and Action Plans
Self Confidence and Self Esteem
Assertiveness & Setting Boundaries
Motivation and Overcoming Procrastination
Developing a Self Care Practice
Loneliness or Isolation
Learning to Set Boundaries
Discovering a Sense of Purpose
Struggles With Substance Use
Academic Success
Exploring Interests and Hobbies
Developing Healthy Habits
Other
What is the current situation that brought about considering peer coaching?
*
What are your thoughts about mental health?
What are your 3 biggest challenges right now?
*
What activities do you enjoy?
*
Are you comfortable with change and how do you handle it?
*
How do you cope when you feel sad, angry, scared or emotional about something?
On a scale of 1-5, how good are you at speaking up when something bothers you?
*
1
2
3
4
5
Not a Word About It
Shout It Out Loud
1 is Not a Word About It, 5 is Shout It Out Loud
What are your top 3 goals that you'd like to work on with a coach?
*
How many stars would you give yourself when it comes to self awareness?
*
1
2
3
4
5
What motivates or inspires you?
*
Describe what living your "best life" would look and feel like with no obstacles:
Can you commit to a weekly meeting with a coach?
*
Is there anything else you would like to share with Noble One that will help us get to know you better?
*
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