By completing the questionnaire below you will help me to guide you clearly towards your goals. In our first session, we will go through the coaching process together and discuss your goals. We'll end the session with what you've gained and together we'll set out the actions you'll take to translate the work you've done into results. In everything to do with the coaching session, we adhere to the ICF Code of Ethics and Conduct. View more here First Name Last Name Email Phone What made you seek out coaching at the time? Through the coaching sessions what do you want to achieve in the next 3 months? Through the coaching sessions what do you want to achieve in the next 3 months? Change 1: Change 2: Change 3: What has prevented you from achieving these results to date? Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Health and exercise 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Career 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Finances 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Family/Friends 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Erotic Relationships 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Social Life/Entertaiment 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Personal Development 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Spirituality (search for purpose in life/achieving inner harmony) 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Physical environment (for example your home, the town/city you live in, the neighbourhood, the climate. 1 2 3 4 5 6 7 8 9 10 Rate yourself from 1 to 10 in each of the areas of life. 10 being perfect, can't get any better, 1 considering that much improvement is needed in that area. Vision of Life Completion 1 2 3 4 5 6 7 8 9 10 What would you say were the 3 biggest achievements of your life so far? Achievement 1: Achievement 2: Achievement 3: What are your main stressors? Main Stressor 1: Main Stressor 2: Main Stressor 3: List 1 to 3 things you are currently putting up with in your life (for example, being overweight, procrastination, time management, office reorganisation Tolerance 1: Tolerance 2: Tolerance 3: What's the hardest thing you've ever had to overcome? Do you think your life today is balanced? Yes or no and why? Do you have a vision for your professional life? If so, what is it? What is it that is missing from your life? What would fill you up the most? What do you expect from me in my role as a coach? When you are "blocked", what can I tell you that will get you back in action? Are you willing to commit yourself in the next 3 months to work on your goals? Time's up
