<p> PLEASE TELL ME ABOUT YOURSELF</p><p>Lynn Bacon Gwinnett Coaching Certified Personal Life Coach [email protected] www.gwinnettcoaching.com</p><p>NEW CLIENT INTAKE PACKET</p><p>(In addition to this form, please feel free to send a picture or yourself, resume, or any other pertinent information.)</p><p>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.</p><p>Fax the completed form to: 770-339-0287 or give in person at first class</p><p>Name (Please Print): ______</p><p>Address: ______</p><p>City ______State ______Zip code: ______</p><p>Phone ______FAX ______Email ______</p><p>Birth date: ______</p><p>AGE: ______</p><p>Favorite Hobbies/Interests: </p><p>______</p><p>______</p><p>______</p><p>Job?: ______</p><p>Employed by: ______</p><p>Client’s Name ______1 Please answer the following questions to assist me in being the best coach I can be for you.</p><p>1. Describe three items you most want to achieve or accomplish as a result of your coaching.</p><p>2. Why do you want to achieve these things?</p><p>3. What has prevented you from achieving them in the past?</p><p>4. How will you know when you have achieved your goals?</p><p>5. What is most important to you in life?</p><p>6. What are you most grateful for in life?</p><p>Client’s Name ______2 7. What would you say have been your 3 greatest accomplishments to date?</p><p>8. What is the hardest thing in life that you have had to overcome?</p><p>9. Who have been your major role models?</p><p>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.</p><p>11.On a scale of one to ten, ten being the high, rate the amount of stress in your life right now.</p><p>12.What are your primary stressors?</p><p>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.</p><p>14.What are the top three major fears in your life?</p><p>15.What motivates you?</p><p>16.What would you like me to do if you get behind on your goals?</p><p>17.What would you like me to do if you miss a coaching session?</p><p>18.How will you know when you are receiving value (i.e. your money’s worth) from the coaching process?</p><p>19.What do you think is NOT possible to achieve in your lifetime that you wish you could?</p><p>Client’s Name ______4</p>