Life Coaching New Client Questionnaire

Directions

Please set aside some alone time to complete this form.

Complete only the sections you feel comfortable sharing with me.

Today's date

General information

Name

Mailing address

Preferred phone

Fax

Email address

Birthday

Marital status

Single (never married)

Single with significant other

Married

Separated

Divorced

Widowed

Spouse/partner

Religion (optional)

Children's names and ages

Occupation

Education

Other information

Your goals

What are the three biggest changes you want to make in your life in the next three months?

What are the three biggest changes you want to make in your life over the next three years?

Your history

What have been your three greatest accomplishments to date?

What is the hardest thing in your life that you have had to overcome?

Who are or have been your major role models?

Have you worked with a coach before or a similar one-on-one adult relationship (e.g., tennis coach, piano teacher)?

Yes

What major transitions have you had in the past two years? Entering or approaching a new decade, a new relationship, a new job, a new role, a new residence, change in children's ages/states, etc.?

Improvements

Please list any improvements you would like to make in the following areas of your life:

Your life

Who are the key people in your life. and what do they provide for you?

Is your life one of your choosing? If not, which parts are being chosen for you?

What is your favorite part of a typical day?

What is your least favorite part of a typical day?

What gives you the most happiness in your life right now?

On a scale of 1 to 10 (10 high), rate how happy you are right now.

What gives you the most meaning in your life right now?

On a scale of 1 to 10 (10 high), rate how meaningful is your life right now.

Looking at the past six months of your life, do you like the direction your life is moving?

On a scale of 1 to 10 (10 high), rate the amount of stress in your life right now.

What are your primary stressors?

List five things that you are tolerating or putting up with in your life at present (e.g., info you can’t find, clutter, rude friends, poor lighting, tight shoes, dented car, job dissatisfaction, dead plants, broken equipment, old appliances)

Yourself

List five adjectives that describe you at your best:

List five adjectives that describe you at your worst.

What are your three major concerns/fears about yourself?

What are your three major concerns/fears about life?

What motivates you?

What are you learning/accepting about yourself at present?

Coaching you

What would you like me to do if you get behind on your goals?

How will you know when you are receiving value (i.e. your money’s worth) from the coaching process?

What types of approaches discourage you or take away motivation?

Do you enjoy self-assessments and improvement programs?

Here are ways coaching clients use me. Rank order these in terms of what you want most out of our coaching partnership, with 1 being the highest and 10 being the lowest.

Brainstorming strategies together

Support, encouragement and validation

Insight into who you are and your potential

Painting a vision of what you can become or accomplish

Exploring and removing blocks and obstacles to your success

Accountability; checking up on goals

Working through self-improvement programs together

Suggesting or designing action steps

Strategic planning

Directness; asking hard questions; challenging you to move forward

Potential and possibility

Do you have a personal or professional vision? If so, what is it?

What would you like to contribute to the world?

What do you think is NOT possible to achieve in your lifetime that you wish you could?

What is a dream or goal you have given up on?

What part of yourself, if any, have you given up on?

On a scale of 1 to 10 (10 high), rate the quality of your life today.

If you reach the age of 95, having continued to live your life and order your time the way you are right now, what regrets do you think you will have? (Tip: complete the statement “I wish I had…”) Do not include things from the past—only things you will regret if you continue your exact present path.

Coaching Questionnaire