Spur Us On Coaching: New Client Intake Form

Spur Us On Coaching

Intake Form
This Intake Form is an opportunity for you to pause and reflect on where you are right now. Your responses help me better understand what matters most to you and allow us to begin our work together with clarity and intention. The form should take around 20 minutes to complete.

During our time together, we’ll explore some of your reflections, look more closely at your goals, and begin identifying the insights and next steps that will move you forward.

Thank you for taking the time to complete the form! Once your form is submitted and your contract has been signed and returned, I will send a Calendy link to schedule our six sessions.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
What is your age?
What is your time zone and general availability?
What is your current occupation or role? (student, athlete, artist, professional, etc.)*
I am: (Check all that apply.)*

A leader in my industry:A small business owner:An educator:I serve in a ministry role:A rodeo athlete:Other:
If you are a rodeo athlete, which events do you compete in?*

BarebackSaddle BroncBull RidingTeam RopingTie DownSteer WrestlingBreakawayBarrel RacingGoat TyingOther:I'm not a rodeo athlete.
If you are a rodeo athlete, what is your level of competition? Check all that apply.*

Junior HighHigh SchoolCollegeAmateurJackpots OnlyPRCA/WPRAI'm not a rodeo athlete.
If other, fill in here.
What area of life, performance, or work are you most focused on improving right now?*
What do you enjoy most about it?*
When do you tend to feel most confident in your work or performance?*
What has been your biggest mental or emotional challenge in the arena or your leadership recently? (Check all that apply.)*

Performance AnxietyFear of FailureOverthinkingHesitationSelf DoubtStruggling Under PressureTrouble FinishingFrustration or AngerHard time letting go of mistakes.Other
What have you already tried to overcome these challenges?(Example: journaling, visualization, talking to my coach, avoiding situations, focusing on fundamentals, etc.)*
What helps you regain focus or confidence after a setback?*
What would you most like to improve through coaching?*
What are your short-term goals right now?*
What are your longer-term goals?*
On a scale of 1–10, how ready do you feel to commit to the work of coaching right now?*

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Why do you feel NOW is the right time to get mental performance coaching?*
Do you feel you currently have the time, energy, and mental space to engage in coaching?*

YesMostlyUnsure
Are there any circumstances or commitments that could make it difficult for you to follow through on the work of coaching right now?*
What type of support are you hoping to receive from a coach?*
Optional: Is there anything else you would like me to know before we begin working together?
Optional: Do you have any existing documents or files (like a goal sheet, resume, or current plan) you wish to share?

Cancelof
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