New Coaching Client Profile Form

Name
First Last
Date
Date Format: MM slash DD slash YYYY
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Birth Date (Month/Day only)
Your Profession
Background
What should I know about your background or history that you believe will help me understand you and allow me to better support you?
What motivates you?
What habits, activities, or thought processes do you believe need to be dropped, simplified, or let go of in order to truly move forward, quickly?
Is there anything else I should know? (e.g. are you currently in therapy, on medication, in a twelve-step program, etc.?)
Your Goals
Working with a coach usually generates accelerated personal growth. Most clients use a coach to accomplish several specific goals.
What are the 1-3 most important things you'd like to accomplish as we work together over the next months? Please be very specific.
What change in you needs to take place so you can accomplish these objectives?
What, if anything, is likely to get in the way or prevent you from accomplishing any of these things?
What's the most important thing you need from me as we work on these objectives?

Background