Coaching Intake Form
Thank you for your interest in coaching. Coaching is a collaborative process focused on growth, clarity, and forward movement. This short questionnaire helps determine whether coaching is the right fit for your goals and whether we would work well together. Please answer thoughtfully - there are no right or wrong answers.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Occupation/Role (e.g., athlete, artist, student, professional)
*
How did you hear about my Coaching Services? Select all that apply.
*
Referral
Social Media
Event/Presentation
Website
Other
What prompted you to explore coaching right now?
*
Describe the biggest challenge you’re currently facing.
*
If this challenge were solved, what would your life or work look like differently?
*
What are 1–3 goals you would like coaching to help you accomplish?
*
What would success from coaching look like six months from now?
*
Coaching works best when clients are ready to take ownership of their growth. On a scale of 1–10, how ready are you to make meaningful changes right now?
*
Just Exploring
1
2
3
4
5
6
7
8
9
Fully Committed
10
1 is Just Exploring, 10 is Fully Committed
What else would you like me to know about you before we speak?
*
Submit
Should be Empty: