Coaching Intake Questionnaire

Please take a few minutes to complete this form. Your responses help me understand your needs and goals, ensuring our coaching sessions are effective and aligned with your aspirations.

All fields are required unless marked optional.

Personal Information

1. Full Name

2. Preferred Name (optional)

3. Email ID

4. Phone No.

5. Age & Gender

6. Life satisfaction (1 to 10)

1 = Not satisfied at all, 10 = Extremely satisfied

Goals and Direction

7. Goals and aspirations

8. Short-term and long-term objectives

Commitment and Availability

9. Are you committed to actively participating and completing exercises?

Yes No Other

If “Other”, please specify

10. Time per week for coaching

Prior Experience

11. Previous experience with coaching or development work

Yes/No. If yes, briefly share experience and results achieved.

Expectations and Preferred Approach

12. Expectations from coaching and success definition

13. Open to new perspectives and change? (Yes/No)

14. Preferred coaching style or approach

15. What is bothering you?

Additional Context

16. Anything else you’d like to share

Discovery and Communication

17. How did you hear about me?

18. Preferred contact method

Consent and Agreement

By submitting this form, you confirm the information provided is accurate to the best of your knowledge, and you agree to engage in coaching sessions based on the details shared.