Client Intake Form Name * Name First First Last Last Pronouns Email: * Phone Number: * Location: (e.g. City, State, Country) * Your employer: * Your job title: Website/URL or LinkedIn Profile My main focus area is: * Finding a new career pathGetting a promotion or new role in my current fieldLeadership and professional developmentA combination of things I would work better with a coach whose style is: * Very warm and friendlyA little tough and can challenge meSomewhere in betweenI don't have a preference I would prefer the coaching approach to be: * Very organized structured More open and free-flowingSomewhere in betweenI don't have a preference Would you rather? * Your coach lead the conversationsI lead the conversations for my coaching sessions Most coaches will give you some type of homework between sessions to make sure you see progress. What do you prefer? * I would love to work through a structured programI'm open to doing some exercises and challenges, but I've never been great with homework How do you handle feelings and emotions? * Let's go there. I'll bring tissues.I'd rather not. Any other coach preferences you’d like to note? (e.g. gender) I would like my coaching sessions to be: Daytime during the weekEvening during the weekOn the weekendNo preference What do you want to learn as part of your journey during this program? What do you hope to get out of coaching? How will you know this coaching engagement has been successful? If you have a goal in mind, please write it below: What about that goal scares or concerns you? Do you have any additional comments, requests or preferences? Anything else your coach should know? Submit If you are human, leave this field blank. Δ
