COACHING INTAKE PACKAGE

COACHING INTAKE PACKAGE

Your Foundation for Transformative Work
Thank you for trusting me with this work.
Please complete this intake package before our first session. Take your time, but't overthink it — honest, intuitive, even messy answers are far more valuable than polished ones.
Client Name*
Date*

MonthDayYear

SECTION 1 — PERSONAL INFORMATION
Full Name*

First NameLast Name
Preferred Name / Nickname*
Mobile Phone*
Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Employer / Organization (if applicable)
Is there anything about your identity, culture, heritage, pronouns, or background that you'd like me to know so our work is most respectful and relevant to you?*

SECTION 2 — YOUR VISION & FOCUS

These questions help us map the terrain before we begin. Be as expansive or specific as feels right.
What brings you to coaching at this particular moment in your life?*
What is your vision for your life and/or work over the next 1-3 years?*
If you have a personal mission or purpose statement, share it here (or take a first draft stab at one):*
At the end of your life, what would you most want to celebrate or have been true?*
List the 3 areas you most want to explore, shift, or build in our work together.*
How will you know this investment has been worthwhile? (What does success look, feel, or sound like?)*

SECTION 3 — SELF-KNOWLEDGE

The deeper we understand what drives and depletes you, the more targeted and powerful our work becomes.
Wellbeing Snapshot

Rate your current satisfaction in each area from 1 (very dissatisfied) to 10 (thriving). Be honest — this is your baseline, not a judgment.
Work / Career Score:*
Relationships Score:*
Health & Energy Score:*
Finances Score:*
Personal Fulfillment Score:*
Overall Wellbeing Score:*
What do these scores tell you? Where do you feel the gap most acutely?*
What are your core values? What do you stand for?*
What are your core motivators? What gets you out of bed?*
When do you feel most alive, energized, and fully yourself?*
What puts you in a state of "flow" — where time disappears?*
What drains your energy or leaves you feeling depleted?*
What do you really want? (Don't censor yourself here.)*

How do you define success - in your own words, not society's?*
What fears or doubts tend to show up when you're on the edge of something important?*
(You don't need to go deep here - just name what comes up naturally)
What triggers you or drives you crazy?*
Three Things You Tolerate (But Wish You Didn't). What are you putting up with in your life right now?*
What patterns or habits have you noticed tend to get in your own way?*
(Not a criticism - just what have you observed about yourself over time?)
What is missing from your life that, if present, would make it feel more complete?*

SECTION 4 — PEAK EXPERIENCES & YOUR STORY

Peak experiences can be moments of joy, triumph, clarity, or even challenge and pain — what matters is that they shaped you. Include both 'positive' and 'negative' moments freely.
Three Peak Experiences
1. Describe the experience and why it stands out:*
2. Describe the experience and why it stands out:*
3. Describe the experience and why it stands out:*
Of what are you most proud?*
What changes would you like to make over the next few years so that you're living without regrets?*

Rate each life area and describe what you'd like to shift. Add any areas not listed.*

Rows	What do you want to create / change here?	Priority (High / Med / Low)
Career / Work
Relationships / Family
Health & Wellbeing
Finances
Personal Growth
Purpose / Meaning
Physical Environment
Other (your choice)

SECTION 6 — OUR WORKING RELATIONSHIP

This section is gold. The more honest you are here, the more effective our work together will be. There are no wrong answers.
What should I know about you to make our work most effective? *
(Any quirks, communication preferences, or important context?)
Have you worked with a coach or therapist before? *
(If yes - what worked well? What didn't? What do you want to be different this time?)
What do you want and need most from me as your coach? *
(Challenge? Accountability? Deep listening? Structure? Cheerleading?)
What should I NOT do?*
(Approaches, styles, or behaviors that don't work for you.)
How do you typically avoid difficult-but-powerful conversations or work? *
(Be honest what are your 'escape hatches'?)
If you're stuck, what can I say that will most help you return to action?*
What would cause you to disengage or want to stop our work together? *
(Surfacing this early helps us avoid it - or address it directly if it comes up)
On a scale of 1-10, how ready are you to make real changes right now? (1 = just exploring, 10 = all in - and please say why)*
Is there anything else you'd like me to know before we begin?*
Should be Empty:

SECTION 1 — PERSONAL INFORMATION