Client Intake Form for Life Coaching

To be prepared by client prior to the first session with me. Many thanks.

Name of client:

Mobile:Email:

Background for your coaching experience. About you and your style.
  1. What have been your three biggest milestones in your life?

  1. What is your home structure?: family, partner, important others, animals

  1. How do you spend your leisure time?

  1. What do you want to be doing (or what changes would you like) in 6 months time?

  1. What three changes might be necessary in your life over next few months?

  1. How ready do you feel to tackle these changes?

  1. What might be your purpose(s) in life do you think?

  1. What are four words that you, or others, would describe you at your best?

  1. What four words would describe you when you are tired and stressed?

  1. Results/scores of any self awareness tools you have undertaken eg MBTI, TMI, DISC, HBDI etc

  1. What’s the hardest thing you have had to manage or overcome?

  1. What are your normal coping strategies? How do you stay resilient?

  1. In what circumstances do you feel most settled, balanced and at peace with the world?

  1. In what circumstances do you feel at your most creative?

  1. How do you feel about this transition/time in your life? List all the feelings.

  1. What is your stress/ depression/ anxiety level now? (Scale 1-10, with 10 being very high)

  1. Who are the people you need to support you through any change? Who is your positive cheer squad? Who provide you with ‘nutritious’ support?

  1. What part of yourself, if anything, have you stopped working on?

Working life
  1. Brief details of your work background and/or current position or latest personal development activities?

  1. What do you find/have you found most enjoyable at work; what motivates you at work?

  1. If relevant, describe your team style or leadership and management style.

  1. How do you react to authority?

  1. How well do you communicate and influence? What social skills are you good at?

  1. What are you learning about yourself at this point of your life?

Other concerns for self
  1. When was your last break or holiday?

  1. What sort of inner dialogue do you have going on? If negative self talk what is it?

  1. What are the range of options you have ruminated on about what comes next for you – in terms of work, study, relationships?

  1. How have you been at taking care of yourself?

  1. What further learning or skills development have you wanted to do? Work or pleasure.

  1. Have you ever suffered from anxiety or depression? Medications?

  1. Do you like self assessment tools to encourage self awareness?

  1. What is your preferred learning style? Eg Action, theory, experimenting, reading or reflection?

  1. What have been your obstacles to learning in the past?

  1. How can I, as coach, best help you? – e.g. how would you like me to keep you on track, what would you like me to do if you are getting behind in your goals and intentions?

Other?

Other information – assessment tools you might like to try for free:

Professor Martin Seligman (author of Learning Optimism and Authentic Happiness) says there are three ways to live your life with the third way being the key to a contented life:

  1. A pleasurable life – having fun, buying things, parties, being with people
  2. An engaged life – using your ‘strengths’ for yourself; being ‘in the flow’ at work and home
  3. A meaningful life – using your ‘strengths’ in the service of others

To identify your top five strengths: Dr Seligman’s VIA Signature Strengths Questionnaire can be found at University of Pennsylvania website:

This is a free questionnaire. After registering on the site your results will be used anonymously for continuous research. Dr Seligman has raised over $100m for research into positive psychology – one of the foundations for successful coaching.)

Thank you for completing this.

It will make our time together most productive!

Intake form for Life CoachingPage 1