Performance Coaching Client Intake Form Please enable JavaScript in your browser to complete this form.Full NameFirstLastPreferred NameAgeEmailPhone Numbers are a coaching OccupationMarital StatusChildren (if applicable)1. What inspired you to seek coaching at this time?2. What are your top 3 goals for the next 90 days?3. What would you like to achieve over the next 6-12 months?4. If our coaching relationship is successful, what will be different in your life one year from now?5. What area of your life would you most like to improve?CareerRelationshipsHealth/FitnessFinancesConfidenceLeadershipTime ManagementPurpose & FulfillmentOther6. Other (please specify)7. What is the biggest challenge preventing you from achieving your goals?8. What have you already tried to overcome this challenge?9. What habits or behaviors do you believe are holding you back?10. What areas of your life currently feel out of alignment?11. On a Scale of 1-10, how satisfied are you with Health & Fitness? Selected Value: 0 12. On a Scale of 1-10, how satisfied are you with Relationships? Selected Value: 0 13. On a Scale of 1-10, how satisfied are you with Career? Selected Value: 0 14. On a Scale of 1-10, how satisfied are you with Finances? Selected Value: 0 15. On a Scale of 1-10, how satisfied are you with Personal Growth? Selected Value: 0 16. On a Scale of 1-10, how satisfied are you with Confidence? Selected Value: 0 17. On a Scale of 1-10, how satisfied are you with Work-Life Balance? Selected Value: 1 18. On a scale of 1–10, how disciplined do you feel right now? Why?19. Are you currently following a structured fitness routine? (YES/NO)YESNO20. Describe your structured fitness routine21. What are your greatest strengths?22. What accomplishments are you most proud of?23. What motivates you to keep moving forward during difficult times?24. Why is now the right time for you to invest in yourself?25. On a scale of 1-10, how committed are you to making meaningful changes?26. What might prevent you from fully committing to the coaching process?27. How do you prefer to be held accountable?28. Describe your ideal life three years from now?29. If there were no limitations, what would you pursue?30. What does success mean to you personally?31. Is there anything else you would like me to know before our first session?32. Emergency Contact Name & Phone:33. Client Signature: _______________________________________ Date: _____________Submit
