The Pivot Partnership- Executive Transition Coaching Intake Form

Executive Transition Coaching Intake Form

Please complete this form to help us understand your background, goals, and preferences for executive transition coaching.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Current City & State*
Preferred method of contact*
Current job title or professional role*
Industry you work in*
How long have you been in your current role? (e.g., 2 years, 6 months)*
How many years of leadership or management experience do you have?*
What size organization do you currently work for?*

Self-employedSmall business (1–50 employees)Mid-size organizationLarge organizationGovernment/Federal agency
What type of transition are you currently experiencing?*

Promotion to a leadership roleStarting a new positionCareer changeLeadership challenges in current roleReturning to work after a breakPreparing for retirement or next phaseOther
What prompted you to seek executive transition coaching at this time?*
What are the biggest challenges you are currently facing professionally?*
What would success look like for you in the next 6–12 months?*
What leadership responsibilities do you currently hold?*
What aspects of leadership feel most natural to you?*
What leadership challenges are you struggling with right now?*
Are there specific workplace dynamics you want support navigating?

Organizational politicsTeam conflictCommunication challengesConfidence or imposter syndromeManaging difficult conversationsOther
What personal strengths have helped you reach your current position?
What areas of growth would you like to develop during coaching?
How confident do you currently feel in your leadership abilities?*

Very confidentSomewhat confidentUnsureStruggling
What internal or personal barriers may be impacting your leadership?
What are your top three goals for executive transition coaching?*
What skills or insights would you like to gain from this experience?
How will you measure progress or success from coaching?
On a scale of 1–10, how ready are you to make meaningful professional changes?*
What support systems do you currently have in place (mentor, supervisor, coach, etc.)?
Are you open to honest feedback and strategic accountability during coaching?*

YesNoUnsure
Are you interested in:

Individual executive coachingLeadership strategy sessionsCareer transition supportOrganizational leadership consultation
Preferred session format

VirtualIn-personHybrid
How did you hear about this coaching service?
What is one leadership or career breakthrough you hope to achieve through coaching?
Is there anything else you would like your coach to know before your first session?
Should be Empty: