Coaching Client Information
Assessment and Profile Development
We are looking forward to working with you in your pre-coaching assessment phase! Your assistance in completing the following will help guide me in achieving the successful coaching outcomes we both desire. Please answer as extensively as appropriate for your situation.
Name
First Name
Last Name
Email
example@example.com
Office Phone Number
-
Area Code
Phone Number
Fax Number
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Mobile Phone Number
-
Area Code
Phone Number
Preferred Phone Number to use:
Office
Mobile
Home
Best times to call?
Birthdate
Are you
Married
Significant Other
Single
Divorced
Spouse/SO Name
Spouse/SO Birthdate
Children (names and ages please):
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Name:
Office Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Mailing Address
Home
Office
1. How would you describe yourself?
Gregarious, stressed, down, idea people, creative, etc.
2. What major challenges/problems or opportunities are present for you now? Please list in order of importance:
3. What is your understanding of and experience with strategic planning?
3. How sophisticated are you in your understanding of Strategic Planning?
4. How sophisticated are you in your understanding of behavior, learning, motivation, and values?
5. How much planning/development work have you done Personally? When?
Please describe in chronological order.
6. How successful were you in carrying out what you planned in #5?
Please describe in chronological order.
7. How much planning/development work have you done Professionally? When?
Please describe in chronological order.
8. How successful were you in carrying what you planned in #7?
Please describe in chronological order.
9. To what do you ascribe your success or lack of success in completing prior work?
10. Have you had any bad experiences in the last 5 years?
Please describe
11. My/Our desired outcomes/goals from the coaching continuum in order of importance are:
What do you hope to gain from this experience?
12. What personal goals do you have in doing this work with us in order of importance?
What do you hope to gain from this experience?
13. What have you done or are you currently doing to address these personal problems/challenges in addition to your upcoming work with us?
14. How effective have these actions been to correcting these problems? And, why or why not?
15. Other lines of business or vocational pursuits you wish to pursue beyond clinical practice that you’d like Coaching around?
16. Personal debt amount:
17. Repayment terms and interest:
18. Business debt amount:
19. Repayment terms and interest rate:
18. What have you done or are you currently doing to address your problems/challenges in addition to your upcoming work with us?
16. How effective have these actions been to correcting these problems?
17. Why or Why not?
18. Other Comments:
Submit
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