Please Tell Me About Yourself

PLEASE TELL ME ABOUT YOURSELF

Lynn Bacon Gwinnett Coaching Certified Personal Life Coach [email protected] www.gwinnettcoaching.com

NEW CLIENT INTAKE PACKET

(In addition to this form, please feel free to send a picture or yourself, resume, or any other pertinent information.)

Congratulations on enrolling into a Personal Life Coaching Program. Please take a few minutes to complete this form. All information is confidential and will be used exclusively by your coach to assist you to create the results to which you are committed.

Fax the completed form to: 770-339-0287 or give in person at first class

Name (Please Print): ______

Address: ______

City ______State ______Zip code: ______

Phone ______FAX ______Email ______

Birth date: ______

AGE: ______

Favorite Hobbies/Interests:

______

Job?: ______

Employed by: ______

Client’s Name ______1 Please answer the following questions to assist me in being the best coach I can be for you.

1. Describe three items you most want to achieve or accomplish as a result of your coaching.

2. Why do you want to achieve these things?

3. What has prevented you from achieving them in the past?

4. How will you know when you have achieved your goals?

5. What is most important to you in life?

6. What are you most grateful for in life?

Client’s Name ______2 7. What would you say have been your 3 greatest accomplishments to date?

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

9. Who have been your major role models?

10.What major transitions have you had in the past couple of years? Some examples might be … a change in relationship status, a move, a new job, a new role, entering a new decade, etc.

11.On a scale of one to ten, ten being the high, rate the amount of stress in your life right now.

12.What are your primary stressors?

Client’s Name ______3 13.List 5 things you are tolerating or putting up with in your life at present. Some examples may be clutter, rude friends, a poor environment, conversations that need closure, etc.

14.What are the top three major fears in your life?

15.What motivates you?

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

17.What would you like me to do if you miss a coaching session?

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

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

Client’s Name ______4